Thank you for your very interesting and valid comments. I take this opportunity to quote some of the very crucial figures (percentages) which seem to be responsible for causing all the controversy and hesitation on the part of some experts in this field in advocating routine radio frequency ablation (RFA) for individuals with asymptomatic WPW findings.
The risk of sudden death in WPW is approximately 0.1% per year overall and may be as high as 0.6% per year in “high risk” patients [1, 2].
As for coronary injuries due to RFA, the reported incidences of injury were 0.03% in children , and 0.06-0.1% in adults . Solomon et al have reported a 1.3% incidence of coronary artery injury in 70 patients following RFA for accessory pathway-mediated tachycardias .
The percentage figures for these major complications are indeed alarmingly too close to the 0.1% risk of sudden death due to WPW. This is the crucial reason why the actual rates of sudden death due to WPW syndrome and that due to RFA need to be ascertained. It is likely to be a difficult task given the relative rarity of the condition and the length of follow up needed.At the present time, the cardiologists may have to decide only on a case-to-case basis.
1. Andrew D Blaufox, MD. Catheter Ablation of Tachyarrhythmias in Small Children. Indian Pacing Electrophysiol J. 2005 Jan–Mar; 5(1): 51–62.
2. Klein GJ, Bashere TM, Sellers TD. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. NEJM. 1979;301:1080–1085.
3. Kugle JD, Danford DA, Houston K, et al. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol. 1997;804:1438–1443.
4. Calkins H, Langberg J, Sousa J, et al. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Abbreviated therapeutic approach to Wolff-Parkinson-White syndrome. Circulation. 1992;85:1337–1346.
5. Solomon AJ, Tracy CM, Swartz JF, et al. Effect on Coronary Artery Anatomy of Radiofrequency Catheter Ablation of Atrial Insertion Sites of Accessory Pathways. J Am Coll Cardiol. 1993;21:1440–1444.