When should we recommend catheter ablation for patients with the Wolff-Parkinson-White syndrome?

Catheter ablation has been proven as very effective and safe therapy for patients with symptomatic Wolff-Parkinson-White (WPW) syndrome. Its application in asymptomatic individuals with WPW pattern remains controversial. This review will elaborate on the role of catheter ablation in symptomatic and asymptomatic patients with WPW pattern on ECG.

Several recent prospective studies evaluated invasive risk stratification followed by prophylactic catheter ablation in asymptomatic patients with WPW pattern. Inducibility of arrhythmias in these patients during invasive electrophysiological study was shown to predict the development of future symptomatic arrhythmias. Although ablation of accessory pathways performed in 'inducible' patients decreased the incidence of subsequent symptomatic arrhythmias, the studies were not powered to detect a reduction in life-threatening arrhythmias.

Radiofrequency catheter ablation remains the first-line therapy for patients with symptomatic WPW syndrome. Invasive electrophysiological study and possible ablation of accessory pathway may be offered to well informed asymptomatic individuals with WPW if they are willing to trade the very small risk of subsequent sudden death or incapacity for a small immediate procedural risk of serious complications or death. Asymptomatic patients may require invasive risk stratification and possible catheter ablation for important social or professional reasons.