The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: A long-term follow-up of 22 years

Background Wolff-Parkinson-White (WPW) syndrome poses a risk for tachyarrhy thmias and sudden cardiac death. Most WPW studies have relatively limited n umbers of subjects and brief follow-up periods. Methods We reviewed records of 238 consecutive military aviators with WPW s yndrome evaluated from 1955 to 1999. Follow-up was by questionnaires, telep hone interviews, or death certificates. Events included sudden cardiac deat h and supraventricular tachycardia (SVT) (by electrocardiographic [ECG] doc umentation or suggestive symptoms). Results The mean age was 34.3 years (range 17-56 years). Forty-two (42/238, 17.6%) had SVT (WPW syndrome) and 196 of 238 (82.4%) had the WPW ECG patte rn only, The mean follow-up of 21.8 years (range 2-41 years) was obtained o n 228 of 238 (96%) for a total of 4906 patient-years, Sudden cardiac death occurred in 1 of 228, an incidence of 0.0002 per patient-year (95% confiden ce interval 0.0-0.001). SVT occurred in 47 of 228 (20.6%) or 0.01 per patie nt-year. One hundred eighty-seven (187/228, 82%) initially had the WPW ECG pattern only; 28 of 187 (15.0%) reported SVT during follow-up. Forty-one (4 1/228, 18%) initially had WPW syndrome; 19 of 41(46.3%) reported additional SVT during follow-up. Conclusion Sudden cardiac death risk was low (0.02%/patient-year) in this W PW population. The SVT incidence was 1% per patient-year. Referral bias and some characteristics of the unique military aviator population may partly account for these low event rates. However, these results may be more appli cable to unselected populations than are tertiary referral-based studies.