Prophylactic Radiofrequency Ablation in Asymptomatic Wolff-Parkinson-White Patients Is Not Yet a Good Strategy: A Decision Analysis

Background —Therapeutic management of asymptomatic patients with a Wolff-Parkinson-White (WPW) pattern is controversial. We compared the risk-benefit ratios between prophylactic radio frequency (RF) ablation and no treatment in asymptomatic WPW patients. Methods and Results —Decision analysis software was used to construct a risk-benefit decision tree. The target population consisted of 20-40 year old asymptomatic WPW patients without structural fatal heart disease or a family history of sudden cardiac death. Baseline estimates of sudden death and RF ablation complication rates were obtained from the literature, an empirical data survey, and expert opinion. The outcome measure was death within 10 years. Sensitivity analyses determined the variables that significantly impacted the decision to ablate or not. Threshold analyses evaluated the effects of key variables and the optimum policy. At baseline, the decision to ablate resulted in a reduction of mortality risk of 8.8 patients for 1000 patients compared with abstention. It is necessary to treat 112 asymptomatic WPW patients to save one life over ten years. Sensitivity analysis showed that 3 variables significantly impacted the decision to ablate: (1) complication of RF ablation; (2) success of RF ablation; and (3) sudden death in asymptomatic WPW patients. Conclusions —This study provides a decision aid for treating asymptomatic patients with the WPW electrocardiogram pattern. Using the model and the population we tested, prophylactic catheter ablation is not yet ready for widespread clinical use.