Intermittent Preexcitation and the Risk of Sudden Death: The Exception That Proves the Rule?

Application of the 2015 ACC/AHA/HRS guidelines for risk stratification for sudden death in adult patients with asymptomatic pre-excitation

The management of the asymptomatic pre-excited patient largely hinges on risk stratification and individual patient considerations and choice. A high threshold to treat patients may lead to a small overall risk of death while a low threshold clearly leads to increased invasive testing and ablation with associated cost and procedural risk. A firm recommendation to uniformly assess all by electrophysiology study or, alternatively, reassure all is inappropriate and unjustified by data as reflected in the recent guideline recommendations. The use of noninvasive and invasive parameters to identify the potentially at-risk individual with surveillance for symptoms in those comfortable with this approach or ablation for those choosing this alternative for individual reasons remains the cornerstone of best practice.

The Wolf-Parkinson-White ECG Pattern - Assessing the Mortality Risk

The presence of a Wolf-Parkinson-White (WPW) pattern is not uncommonly discovered on a life insurance applicant's ECG. How does one determine the appropriate mortality risk in this population? This article will discuss the risk of sudden cardiac death (SCD), the interpretation of electrophysiology testing results, and risk-stratification both for asymptomatic individuals and those who have had ablation treatment.