Impact of catheter ablation in asymptomatic patients with pre-excitation syndrome - real world evidence

BACKGROUND: Pre-excitation syndromes such as Wolff-Parkinson-White increase risks of tachyarrhythmias and sudden cardiac death. While symptomatic patients undergo ablation, optimal management of asymptomatic individuals remains debated. This study aims to evaluate long-term outcomes of catheter ablation versus conservative management in asymptomatic patients utilizing real-world data. METHODS: In this observational cohort study using the U.S. Collaborative Network in TriNetX, patients ≥ 12 to 50 years with asymptomatic pre-excitation between September 1, 2010 and October 1, 2024 were identified. After 1:1 propensity score matching, 5,852 patients were included. The primary endpoint was all-cause mortality. Secondary endpoints included hospitalization, syncope, new onset of heart failure (HF), ventricular tachycardia/fibrillation (VT/VF), atrial fibrillation (AF) and antiarrhythmic drug (AAD) use up to 10 years of follow-up. Outcomes were compared between patients undergoing ablation versus those receiving medical therapy (GDMT). RESULTS: Over a mean follow-up of 1133 ± 1166 days, ablation was associated with reduced risks of the all-cause mortality (hazard ratio (HR) 0.25, 95%CI:0.13-0.48, p < 0.001), HF onset (HR 0.48, 95%CI:0.26-0.85, p = 0.011) and hospitalization rates (HR 0.47, 95%CI:0.37-0.60, p < 0.001). No significant differences were observed for new onset of VT/VF (HR 0.85, 95%CI:0.51-1.43, p = 0.534), AF (HR 1.61, 95%CI:1.00-2.62, p = 0.051) and syncope (HR 1.50, 95%CI:0.78-2.91, p = 0.224). CONCLUSION: In asymptomatic patients with pre-excitation, catheter ablation was associated with a reduced mortality, fewer hospitalizations, and HF onset. These findings support considering ablation as a proactive strategy in selected asymptomatic individuals.