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Asymptomatic WPW in High-risk Occupation — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyAsymptomatic WPW in High-risk OccupationEECC

A 28-year-old man presents with palpitations. ECG shows delta waves with a short PR interval. He is asymptomatic and has never had documented tachycardia. Echocardiography is normal. He works as a commercial airline pilot. Should catheter ablation be offered?

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Correct answer: B — Yes — catheter ablation should be considered in asymptomatic WPW patients with high-risk occupations (pilots, athletes, military), even without documented arrhythmias, due to the small but real risk of sudden cardiac death from pre-excited AF

Asymptomatic WPW (pre-excitation on ECG without symptoms) carries a small but definite risk of sudden cardiac death (~0.1-0.15%/year) from AF conducting rapidly via the accessory pathway and degenerating into VF. The ESC 2019 SVT Guidelines recommend EP study ± catheter ablation (Class IIa) in asymptomatic WPW patients with high-risk occupations or lifestyles where sudden incapacitation would endanger others (pilots, military, professional athletes) or if EP study reveals a high-risk pathway (short ERP ≤250 ms). Ablation success rates for accessory pathways are >95% with low complication rates (<1%). For asymptomatic patients without high-risk features, the decision is individualised with shared decision-making.

Reference: ESC (2019): Guidelines on SVT Management