Author + information
- Received July 22, 1986
- Revision received January 19, 1987
- Accepted February 2, 1987
- Published online August 1, 1987.
- Arjun D. Sharma, MD, FACC*,1,2,
- Raymond Yee, MD1,2,
- Gerard Guiraudon, MD, FACC1 and
- George J. Klein, MD, FACC1,3
- ↵*Address for reprints: Arjun D. Sharma, MD, University Hospital. PO Box 5339, Station A, London, Ontario, Canada N6A 5A5.
Invasive electrophysiologic testing and noninvasive testing were compared as methods for identifying patients with Wolff-Parkinson-White syndrome at risk for sudden death. Sixty-seven patients were studied, including nine with a history of ventricular fibrillation. Electrophysiologic testing, using the shortest interval between consecutive pre-excited beats (shortest RR interval) ≤250 ms during induced atrial fibrillation to define risk, identified seven of nine patients with previous ventricular fibrillation. The sensitivity increased to 87.5% if one patient with prior amiodarone therapy was excluded. Electrophysiologic testing had a specificity of 48.3% and a low predictive accuracy (18.9%) when using the shortest RR interval (≤250 ms) to identify the risk for sudden death.
Continuous pre-excitation after disopyramide (2 mg/kg body weight, intravenously) had a sensitivity of 71.4%, specificity of 26.1% and predictive accuracy of 12.8% for identifying patients with sudden death. Continuous pre-excitation during an exercise test identified these patients with a sensitivity of 80%, a specificity of 28.6% and a predictive accuracy of 11.8%. These noninvasive tests could also be used to predict the shortest RR interval observed during induced atrial fibrillation. Continuous pre-excitation on both tests used in combination had a sensitivity of 91.2%, a specificity of 66.7% and a predictive accuracy of 75.6% for predicting the shortest RR interval ≤250 ms. Thus, both invasive and noninvasive techniques have a good sensitivity but a low specificity for identifying patients with Wolff-Parkinson-White syndrome and sudden death. Slow ventricular rates during atrial fibrillation and block of accessory pathway conduction by noninvasive methods are associated with a low risk of sudden death.
- Received July 22, 1986.
- Revision received January 19, 1987.
- Accepted February 2, 1987.
- American College of Cardiology Foundation