UTILITY OF FULL ELECTROPHYSIOLOGICAL STUDY BEFORE ACCESSORY PATHWAY ABLATION IN WOLFF-PARKINSON-WHITE-SYNDROME

BACKGROUND: A single catheter technique has been described for ablatio n in patients with Wolff-Parkinson-White syndrome. It is unknown how o ften omission of a standard electrophysiological study would lead to m isdiagnosis based on an assumption that the manifest accessory pathway is responsible for clinical tachycardia. OBJECTIVES: To examine the c ontribution of the standard electrophysiological study versus an abbre viated, single catheter approach in patients with Wolff-Parkinson-Whit e syndrome and an overt delta wave electrocardiographically. PATIENTS AND METHODS: One hundred and fifty consecutive patients with a delta w ave present on electrocardiogram referred for ablation had prior full diagnostic electrophysiological study. RESULTS: In 83% (124 of 150) of patients, the index accessory pathway was responsible for tachycardia and single catheter ablation would suffice. In 11% (17 of 150) of pat ients, the index pathway was not found to be the culprit producing tac hycardia and in another 6% (nine of 150) additional information was ob tained from electrophysiological study with possible clinical signific ance. CONCLUSIONS: Omission of the full diagnostic electrophysiologica l study is acceptable in the majority of patients presenting with a de lta wave on electrocardiogram. However, important clinical information is missed in a sizeable minority of patients.