Editorial On the Need for a Universal Prospective ECG Database

Wolf-Parkinson-White (WPW) is one of the few clinicaldiseases that is mainly diagnosed by the ECG. One of the ultimate goals of modern medicine is to find a method to prevent disease. One of the best examples is catheter ablation of the accessory tracts in patients with WPW that will prevent tachyarrhythmias and sudden cardiac death (SCD) in 95% of the patients. In patients with WPW, catheter ablation is the treatment of choice in the highly symptomatic patient with severe arrhythmias. A major challenge today is to ascertain the benefits versus the risks of doing catheter ablation in the asymptomatic patient with WPW. In this issue of Circulation, Obeyesekere et al.1 with the use of meta-analysis, studied the risk of arrhythmia and sudden death in patients with asymp-tomatic preexcitation and summarized the breadth of pub-lished evidence regarding the risks and benefits of catheter ablation in the asymptomatic patient. This study is an impor-tant milestone in the history of WPW, since its first descrip-tion 82 years ago2 and the ablation of atrioventricular con-duction by use of a catheter was first accomplished in the dog 36 years ago3 and its first use in humans was officially reported 21 years ago.4 The major conclusion of this metic-ulous review is that the available evidence is insufficient to justify the use of catheter ablation in the asymptomatic patient. This conclusion underscores the need to establish a prospective clinical and electrocardiographic database to determine the natural history of WPW (and other ECG abnormalities, as well) from birth to death. Our arguments in support of this proposal are summarized below. Article see p 2308 Characterization of the Asymptomatic Patient The first issue posed by these investigations is the need to establish a clinically relevant definition of the asymptomatic patient. Many patients presenting with an ECG diagnosis of WPW are not aware of the fact that they have this diagnosis and are also not aware of the association of arrhythmias. However, most of these patients do indeed have symptoms of arrhythmias when carefully questioned. In fact, the investi-gators of this study considered that some of the categorized asymptomatic Italian patients1 should have been placed in th