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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this observational cohort study using the U.S. Collaborative Network in TriNetX, patients\u2009\u2265\u200912 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a mean follow-up of 1133\u2009\u00b1\u20091166 days, ablation was associated with reduced risks of the all-cause mortality (hazard ratio (HR) 0.25, 95%CI:0.13\u20130.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), HF onset (HR 0.48, 95%CI:0.26\u20130.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) and hospitalization rates (HR 0.47, 95%CI:0.37\u20130.60,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No significant differences were observed for new onset of VT\/VF (HR 0.85, 95%CI:0.51\u20131.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.534), AF (HR 1.61, 95%CI:1.00-2.62,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.051) and syncope (HR 1.50, 95%CI:0.78\u20132.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.224).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10840-026-02385-9","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:26:49Z","timestamp":1785227209000},"page":"2557-2565","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of catheter ablation in asymptomatic patients with pre-excitation syndrome - real world evidence"],"prefix":"10.1007","volume":"69","author":[{"given":"Maximilian","family":"Moersdorf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Massad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Montaser","family":"Atasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Menassa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Abou-Khalil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex El","family":"Darzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo El","family":"Khoury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qussay","family":"Marashly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"Montiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amitabh C.","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Sohns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nassir","family":"Marrouche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"2385_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15420\/aer.2017.51.2","volume":"7","author":"J Brugada","year":"2018","unstructured":"Brugada J, Keegan R. 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NM also reports being a speaker for Abbott, Biosense Webster, AtriCure and Sanofi. NM also reports receiving research support Abbott, Medtronic, Biosense Webster, Siemens, GE, Boston Scientific, Sanofi, and Samsung. NM also reports having a family member as the CEO of Cardiac Designs. NM also reports being the founder of Marrek, being named in a patent issued for MRI fibrosis imaging and being a previous shareholder of Cardiac Designs. AP reports having served on an advisory board for Novartis (completed). MM received a research grant from the German Heart Foundation. PS is a member of the advisory board of Abbott, J&J MedTec, and Medtronic. CS reports having received lecture fees and is a consultant for J&J Medtech, Boston Scientific, and Medtronic. All other co-authors have no relevant conflict of interest. The authors have no other conflicts of interest to disclose.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}