{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:26:29Z","timestamp":1789043189837,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T00:00:00Z","timestamp":1707955200000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST (bicycle) prior to an electrophysiology study (EPS). Primary data from the EST included loss of pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI\/APERP \u2264 250\u2005ms at EPS, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI\/APERP \u2264 250\u2005ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euae036","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T04:33:58Z","timestamp":1708144438000},"source":"Crossref","is-referenced-by-count":17,"title":["Risk assessment in patients with symptomatic and asymptomatic pre-excitation"],"prefix":"10.1093","volume":"26","author":[{"given":"Anette","family":"Jemtr\u00e9n","sequence":"first","affiliation":[{"name":"Heart and Lung Disease Unit, Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-9692","authenticated-orcid":false,"given":"Serkan","family":"Saygi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge , Department of Medicine Huddinge, Karolinska Institutet, H\u00e4lsov\u00e4gen, 141 86 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0611-8416","authenticated-orcid":false,"given":"Finn","family":"\u00c5kerstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge , Department of Medicine Huddinge, Karolinska Institutet, H\u00e4lsov\u00e4gen, 141 86 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0515-6170","authenticated-orcid":false,"given":"Fahd","family":"Asaad","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge , Department of Medicine Huddinge, Karolinska Institutet, H\u00e4lsov\u00e4gen, 141 86 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6292-9662","authenticated-orcid":false,"given":"Tara","family":"Bourke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge , Department of Medicine Huddinge, Karolinska Institutet, H\u00e4lsov\u00e4gen, 141 86 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4966-1315","authenticated-orcid":false,"given":"Frieder","family":"Braunschweig","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge , Department of Medicine Huddinge, Karolinska Institutet, H\u00e4lsov\u00e4gen, 141 86 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5964-0393","authenticated-orcid":false,"given":"Carina","family":"Carnl\u00f6f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge , Department of Medicine Huddinge, Karolinska Institutet, H\u00e4lsov\u00e4gen, 141 86 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9158-4942","authenticated-orcid":false,"given":"Nikola","family":"Drca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Vascular Centre, Karolinska University Hospital Huddinge , Department of Medicine Huddinge, Karolinska Institutet, H\u00e4lsov\u00e4gen, 141 86 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Insulander","sequence":"additional","affiliation":[{"name":"Department of 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