Utility of full electrophysiological study before accessory pathway ablation in Wolff-Parkinson-White syndrome.

Background: A single catheter technique has been described for ablation in patients with Wolff-Parkinson-White syndrome. It is unknown how often omission of a standard electrophysiological study would lead to misdiagnosis based on an assumption that the manifest accessory pathway is responsible for clinical tachycardia.

Objectives: To examine the contribution of the standard electrophysiological study versus an abbreviated, single catheter approach in patients with Wolff-Parkinson-White syndrome and an overt delta wave electrocardiographically.

Patients And Methods: One hundred and fifty consecutive patients with a delta wave 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 patients, the index pathway was not found to be the culprit producing tachycardia and in another 6% (nine of 150) additional information was obtained from electrophysiological study with possible clinical significance.

Conclusions: Omission of the full diagnostic electrophysiological study is acceptable in the majority of patients presenting with a delta wave on electrocardiogram. However, important clinical information is missed in a sizeable minority of patients.