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Circulation, Vol 87, 866-873, Copyright © 1993 by American Heart Association
TM Munger, DL Packer, SC Hammill, BJ Feldman, KR Bailey, DJ Ballard, DR Holmes Jr and BJ Gersh
BACKGROUND. Virtually all natural history studies of Wolff-Parkinson- White
(WPW) syndrome have been case series and, as such, have been constrained by
referral biases, skewed age and sex distributions, or brief follow-up
periods. The purpose of our study was to examine the natural history, the
development of arrhythmias, and the incidence of sudden death in an entire
cohort of pediatric and adult WPW patients from a community-based local
population. METHODS AND RESULTS. We identified 113 residents of Olmsted
County, Minnesota, during the period 1953-1989 using the centralized
records-linkage system provided by the Mayo Clinic and the Rochester
Epidemiology Program Project. Medical records and ECGs were reviewed to
confirm the diagnosis and to establish pathway location by ECG criteria.
Follow-up, via record review and telephone interview, was complete in 95%
of subjects through 1990. The incidence of newly diagnosed cases was
approximately four per 100,000 per year. Preexcitation was not present on
the initial ECG of 22% of the cohort. Approximately 50% of the population
was asymptomatic at diagnosis, with 30% subsequently having symptoms
related to arrhythmia at follow-up. Two sudden cardiac deaths (SCD)
occurred over 1,338 patient-years of follow-up, yielding an overall SCD
rate of 0.0015 (95% confidence interval, 0.0002-0.0054) per patient-year.
No SCD occurred in patients asymptomatic at diagnosis. CONCLUSIONS. The
incidence of sudden death in a local community-based population is low and
suggests that electrophysiological testing should not be performed
routinely in asymptomatic patients with WPW syndrome. Nevertheless, young,
asymptomatic patients, particularly those < 40 years old, should return
for medical follow-up should symptoms develop.
ARTICLES
A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
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