A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989

T. M. Munger, Douglas L Packer, S. C. Hammill, B. J. Feldman, Kent R Bailey, D. J. Ballard, David Holmes, B. J. Gersh

Research output: Contribution to journalArticle

365 Citations (Scopus)

Abstract

Background. Virtually all natural history studies of Wolff-Parkinson- White (WPW) syndrome have been case series and, as such, have been constrained by referral biases, skewed age and sex distributions, or brief follow-up periods. The purpose of our study was to examine the natural history, the development of arrhythmias, and the incidence of sudden death in an entire cohort of pediatric and adult WPW patients from a community-based local population. Methods and Results. We identified 113 residents of Olmsted County, Minnesota, during the period 1953-1989 using the centralized records- linkage system provided by the Mayo Clinic and the Rochester Epidemiology Program Project. Medical records and ECGs were reviewed to confirm the diagnosis and to establish pathway location by ECG criteria. Follow-up, via record review and telephone interview, was complete in 95% of subjects through 1990. The incidence of newly diagnosed cases was approximately four per 100,000 per year. Preexcitation was not present on the initial ECG of 22% of the cohort. Approximately 50% of the population was asymptomatic at diagnosis, with 30% subsequently having symptoms related to arrhythmia at follow-up. Two sudden cardiac deaths (SCD) occurred over 1,338 patient-years of follow-up, yielding an overall SCD rate of 0.0015 (95% confidence interval, 0.0002-0.0054) per patient-year. No SCD occurred in patients asymptomatic at diagnosis. Conclusions. The incidence of sudden death in a local community-based population is low and suggests that electrophysiological testing should not be performed routinely in asymptomatic patients with WPW syndrome. Nevertheless, young, asymptomatic patients, particularly those <40 years old, should return for medical follow- up should symptoms develop.

Original languageEnglish (US)
Pages (from-to)866-873
Number of pages8
JournalCirculation
Volume87
Issue number3
StatePublished - 1993

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Wolff-Parkinson-White Syndrome
Sudden Cardiac Death
Population
Electrocardiography
Sudden Death
Natural History
Cardiac Arrhythmias
Incidence
Sex Distribution
Age Distribution
Medical Records
Epidemiology
Referral and Consultation
Confidence Intervals
Interviews
Pediatrics
Mortality

Keywords

  • accessory pathways
  • electrocardiography
  • epidemiology
  • sudden death

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Munger, T. M., Packer, D. L., Hammill, S. C., Feldman, B. J., Bailey, K. R., Ballard, D. J., ... Gersh, B. J. (1993). A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation, 87(3), 866-873.

A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. / Munger, T. M.; Packer, Douglas L; Hammill, S. C.; Feldman, B. J.; Bailey, Kent R; Ballard, D. J.; Holmes, David; Gersh, B. J.

In: Circulation, Vol. 87, No. 3, 1993, p. 866-873.

Research output: Contribution to journalArticle

Munger, T. M. ; Packer, Douglas L ; Hammill, S. C. ; Feldman, B. J. ; Bailey, Kent R ; Ballard, D. J. ; Holmes, David ; Gersh, B. J. / A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. In: Circulation. 1993 ; Vol. 87, No. 3. pp. 866-873.
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AU - Holmes, David

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N2 - Background. Virtually all natural history studies of Wolff-Parkinson- White (WPW) syndrome have been case series and, as such, have been constrained by referral biases, skewed age and sex distributions, or brief follow-up periods. The purpose of our study was to examine the natural history, the development of arrhythmias, and the incidence of sudden death in an entire cohort of pediatric and adult WPW patients from a community-based local population. Methods and Results. We identified 113 residents of Olmsted County, Minnesota, during the period 1953-1989 using the centralized records- linkage system provided by the Mayo Clinic and the Rochester Epidemiology Program Project. Medical records and ECGs were reviewed to confirm the diagnosis and to establish pathway location by ECG criteria. Follow-up, via record review and telephone interview, was complete in 95% of subjects through 1990. The incidence of newly diagnosed cases was approximately four per 100,000 per year. Preexcitation was not present on the initial ECG of 22% of the cohort. Approximately 50% of the population was asymptomatic at diagnosis, with 30% subsequently having symptoms related to arrhythmia at follow-up. Two sudden cardiac deaths (SCD) occurred over 1,338 patient-years of follow-up, yielding an overall SCD rate of 0.0015 (95% confidence interval, 0.0002-0.0054) per patient-year. No SCD occurred in patients asymptomatic at diagnosis. Conclusions. The incidence of sudden death in a local community-based population is low and suggests that electrophysiological testing should not be performed routinely in asymptomatic patients with WPW syndrome. Nevertheless, young, asymptomatic patients, particularly those <40 years old, should return for medical follow- up should symptoms develop.

AB - Background. Virtually all natural history studies of Wolff-Parkinson- White (WPW) syndrome have been case series and, as such, have been constrained by referral biases, skewed age and sex distributions, or brief follow-up periods. The purpose of our study was to examine the natural history, the development of arrhythmias, and the incidence of sudden death in an entire cohort of pediatric and adult WPW patients from a community-based local population. Methods and Results. We identified 113 residents of Olmsted County, Minnesota, during the period 1953-1989 using the centralized records- linkage system provided by the Mayo Clinic and the Rochester Epidemiology Program Project. Medical records and ECGs were reviewed to confirm the diagnosis and to establish pathway location by ECG criteria. Follow-up, via record review and telephone interview, was complete in 95% of subjects through 1990. The incidence of newly diagnosed cases was approximately four per 100,000 per year. Preexcitation was not present on the initial ECG of 22% of the cohort. Approximately 50% of the population was asymptomatic at diagnosis, with 30% subsequently having symptoms related to arrhythmia at follow-up. Two sudden cardiac deaths (SCD) occurred over 1,338 patient-years of follow-up, yielding an overall SCD rate of 0.0015 (95% confidence interval, 0.0002-0.0054) per patient-year. No SCD occurred in patients asymptomatic at diagnosis. Conclusions. The incidence of sudden death in a local community-based population is low and suggests that electrophysiological testing should not be performed routinely in asymptomatic patients with WPW syndrome. Nevertheless, young, asymptomatic patients, particularly those <40 years old, should return for medical follow- up should symptoms develop.

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