Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.
Europace. 2013 May;15(5):750-3. doi: 10.1093/europace/eut094.
The aims of this survey was to provide insight into treatment activity, the strategy of treatment, and risk stratification of patients with asymptomatic and symptomatic ventricular pre-excitation across Europe. Fifty-eight centres, members of the European Heart Rhythm Association EP research network, covering 20 countries answered the survey questions. All centres were high-volume ablation centres. A younger person with asymptomatic Wolff-Parkinson-White (WPW) pattern has a higher likelihood of being risk-stratified or receiving ablation therapy compared with an older subject. Two-thirds of centres report that they have observed a decline in the number of patients ablated for an accessory pathway during the last 10 years. Pre-excited atrial fibrillation is rarely seen. Discontinuation of a scheduled WPW ablation due to close vicinity of the accessory pathway to the AV node happens very rarely. Patients with a first episode of pre-excited atrial fibrillation would immediately be referred for catheter ablation to be performed within weeks by 80.4% of the centres. A significant proportion of responders (50.9%) would use electrical cardioversion to restore sinus rhythm in a patient with pre-excited atrial fibrillation. With respect to the choice of antiarrhythmic medication for a patient with pre-excited AF, the majority (80.0%) would choose class 1C antiarrhytmic drugs while waiting for a catheter ablation. A patient seen in the emergency room with a second episode of orthodromic atrioventricular reentry tachycardia would be referred for immediate ablation by 79.2-90.6% of centres depending on the presence of pre-excitation. The volume of paediatric ablations performed on children younger than 12 years was low (46.4%: 0 patients per year; 46.4%: 1-9 patients per year). The majority of responding centres (61-69%) report that their country lack national guidelines dealing with clinical strategies related to WPW. There is a need for national guidelines dealing with clinical strategy in patients with WPW syndrome. Older individuals with asymptomatic WPW pattern have a higher risk of not receiving risk stratification or curative therapy with ablation compared with younger patients, despite the higher risk of developing atrial fibrillation.
本调查旨在深入了解欧洲无症状和有症状心室预激患者的治疗活动、治疗策略和风险分层。欧洲心脏节律协会 EP 研究网络的 58 个中心（覆盖 20 个国家）回答了调查问题。所有中心都是大容量消融中心。与老年患者相比，年轻的无症状 Wolff-Parkinson-White（WPW）模式患者更有可能进行风险分层或接受消融治疗。三分之二的中心报告称，过去 10 年来，因旁道而接受消融治疗的患者数量有所减少。预激性心房颤动很少见。由于旁道与房室结非常接近，导致 WPW 消融计划中止的情况非常罕见。80.4%的中心会立即将首次出现预激性心房颤动的患者转介行导管消融术，且在数周内进行。相当一部分（50.9%）应答者会用电复律使预激性心房颤动患者恢复窦性心律。对于预激性 AF 患者的抗心律失常药物选择，大多数（80.0%）会在等待导管消融术时选择 1C 类抗心律失常药物。79.2-90.6%的中心会立即将因顺向型房室折返性心动过速而第二次就诊于急诊室的患者转介行消融术，取决于是否存在预激。12 岁以下儿童进行的儿科消融量较低（46.4%：每年无患者；46.4%：每年 1-9 名患者）。大多数应答中心（61-69%）报告称，他们的国家缺乏与 WPW 相关的临床策略相关的国家指南。WPW 综合征患者需要制定与临床策略相关的国家指南。与年轻患者相比，无症状 WPW 模式的老年患者接受风险分层或消融治疗的可能性较低，尽管他们发生心房颤动的风险较高。
