Complications
Usually with a history of palpitations and dizziness. SCD due to ventricular fibrillation (VF) is a rare manifestation with an incidence of 0.025% to 0.38%. The risk of cardiac arrest/VF in patients with untreated WPW syndrome is approximately 0.9-2.4 per 1000 person-years.[4] High-risk patients include those with a rapidly conducting accessory pathway (AP) (1:1 AV conduction at >250 bpm) and multiple APs. WPW syndrome accounts for 10% of SCD in the young population.[22] The mode of death is thought to be due to atrial fibrillation with a rapid ventricular response via an AP that induces polymorphic ventricular tachycardia and VF resulting in syncope or SCD. Although syncope in patients with WPW syndrome is considered an ominous prognostic sign, in one study of patients with WPW syndrome referred for electrophysiology study, the incidence of aborted SCD was 28% and 16% in patients with and without a history of syncope, respectively. However, this did not reach statistical significance.
Catheter ablation is generally a safe procedure with an overall complication rate of 4.4% and a major complication rate of less than 1%.
The common minor complications are related to the vascular access, catheter manipulation, transseptal atrial puncture for left-sided accessory pathway ablation, application of radiofrequency energy, and left-sided ablation: bleeding from vascular sites, haematomas, deep venous thrombosis, arteriovenous fistula, pseudoaneurysm at the arterial access sites, pneumothorax, infection.
The risk of major complications is 1.8%: death, related to catheter manipulation, due to valvular damage, perforation of the coronary sinus or myocardial wall, coronary artery dissection, and thrombosis (0.08% to 0.2%), or related to the delivery of radiofrequency energy (atrioventricular block, 0.17% to 1.0%), myocardial perforation, coronary artery spasm or occlusion, transient ischaemic attacks and cerebrovascular accidents, or pericardial tamponade (0.13% and 1.1%), mostly occurs during transseptal puncture, but can occur during the application of radiofrequency energy.
Use of this content is subject to our disclaimer