Does age influence the indications for investigating asymptomatic Wolff-Parkinson-White syndrome?

Sudden death may be the presenting symptom of a Wolff-Parkinson-White syndr ome. Electrophysiological investigation is the best method of identifying h igh risk cases. The aim of this study was to determine whether this investi gation should be proposed to all patients, irrespective of age. Transoesoph ageal stimulation was performed in 85 asymptomatic patients with the Wolff- Parkinson-White syndrome. Of the 85 subjects. 13 were under 20 years of age , 30 under 30 years, 15 under 40 years, 16 under 50 years and 11 between 50 and 69 years of age. A protocol of incremental stimulation until 2(nd) deg ree AVE was attained and programmed atrial stimulation with one or two extr astimuli delivered on 2 paced cycles (600 and 400 ms) was used under basal conditions and with Isoprenaline. A malignant form of the condition was def ined as the demonstration of two abnormalities : rapid conduction in the bu ndle of Kent (over 240/min) under basal conditions or over 300/min after Is oprenaline, and if it induced sustained atrial fibrillation (> 1 min). The results were: [GRAPHICS] PJT : paroxysmal jynctional tachycardia; AF : atrial fibrillation. In conclusion, the number of malignant forms of the Wolff-Parkinson-White s yndrome is exactly the same, irrespective of age. Elderly patients remain a t risk of malignant WPW syndrome because of the increased incidence of atri al fibrillation. Therefore, the authors recommend systematic evaluation of this syndrome if the patient has an active life-style especially with regar d to sporting activities.