When can ablation be considered a reasonable option in young asymptomatic patients with a Wolff-Parkinson-White ECG?

Abstract

Successful catheter ablation of the accessory pathways eliminates the small risk of sudden death associated with the Wolff-Parkinson-White (WPW) ECG in asymptomatic patients. The low rate of serious complications and even death associated with catheter ablation arguable offsets the benefit associated with uniform catheter ablation in this population. The low positive predictive value of non-invasive and invasive variables along with the cost also argue against a uniform invasive approach in asymptomatic patients. Nonetheless, an invasive strategy in certain clinical circumstances and in patients who remain concerned of the small risk of life-threatening arrhythmia as a first presentation after a thoughtful discussion of the risks and benefits of an invasive approach is reasonable.