TY  - JOUR
PY  - 2024//
TI  - Risk assessment in patients with symptomatic and asymptomatic pre-excitation
JO  - Europace
A1  - Jemtrén, Anette
A1  - Saygi, Serkan
A1  - Åkerström, Finn
A1  - Asaad, Fahd
A1  - Bourke, Tara
A1  - Braunschweig, Frieder
A1  - Carnlöf, Carina
A1  - Drca, Nikola
A1  - Insulander, Per
A1  - Kennebäck, Göran
A1  - Nordin, Astrid Paul
A1  - Sadigh, Bita
A1  - Rickenlund, Anette
A1  - Saluveer, Ott
A1  - Schwieler, Jonas
A1  - Svennberg, Emma
A1  - Tapanainen, Jari
A1  - Turkmen, Yusuf
A1  - Bastani, Hamid
A1  - Jensen-Urstad, Mats
SP  - euae036
EP  - euae036
VL  - 26
IS  - 2
N2  - 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. <br><br>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. <br><br>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).<p />  <p>Language: en</p>
LA  - en
SN  - 1099-5129
UR  - http://dx.doi.org/10.1093/europace/euae036
ID  - ref1
ER  -