Dataset Information

Risk assessment in patients with symptomatic and asymptomatic pre-excitation.

ABSTRACT:

Aims

Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation.

Methods and results

This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST (bicycle) prior to an electrophysiology study (EPS). Primary data from the EST included loss of pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI/APERP ≤ 250 ms at EPS, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI/APERP ≤ 250 ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups.

Conclusion

Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935).

SUBMITTER: Jemtren A

PROVIDER: S-EPMC10873488 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Risk assessment in patients with symptomatic and asymptomatic pre-excitation.

Jemtrén Anette A Saygi Serkan S Åkerström Finn F Asaad Fahd F Bourke Tara T Braunschweig Frieder F Carnlöf Carina C Drca Nikola N Insulander Per P Kennebäck Göran G Nordin Astrid Paul AP Sadigh Bita B Rickenlund Anette A Saluveer Ott O Schwieler Jonas J Svennberg Emma E Tapanainen Jari J Turkmen Yusuf Y Bastani Hamid H Jensen-Urstad Mats M

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 20240201 2

<h4>Aims</h4>Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation.<h4>Methods and results</h4>This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST ...[more]

PMID: 38363996

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Dataset Information

Risk assessment in patients with symptomatic and asymptomatic pre-excitation.

Aims

Methods and results

Conclusion

Publications

Risk assessment in patients with symptomatic and asymptomatic pre-excitation.

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