Intermittent Ventricular Pre-Excitation: Clinical Features and Electrophysiological Properties

Background: Intermittent ventricular pre-excitation has long been considered a low-risk marker for sudden death. Accessory pathways (APs) with high-risk intermittent antegrade conductive properties may exist, but this still represents a gray area in current guidelines. We evaluated differences in risk characteristics between symptomatic and asymptomatic patients with intermittent pre-excitation (IPX) and those with persistent pre-excitation (PPX) in a multicenter international registry. Methods: 392 consecutive patients [IPX: 79 (20.15%); PPX: 313 (79.85%)] underwent electrophysiological (EP) study. Data on arrhythmia inducibility (AVRT/AF), AP antegrade conduction properties (ERP/SPERRI), site, and number were collected. Results: No significant differences were found in demographic characteristics and EP features between PPX and IPX patients, including antegrade conductive properties, prevalence of multiple APs, and AP locations, except for AVRT inducibility which was more frequent in IPX group. Similarly, no differences were detected between symptomatic and asymptomatic IPX patients. Conclusions: Except for AVRT inducibility, our study shows no significant differences in demographic and other electrophysiological features between PPX and IPX patients. Likewise, no differences in demographic and EP features were detected between symptomatic and asymptomatic IPX patients. Therefore, intermittent pre-excitation is an unreliable noninvasive marker of arrhythmic risk and it warrants an invasive risk assessment via EP study.