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Wolff–Parkinson–White syndrome: lessons learnt and lessons remaining

Published online by Cambridge University Press:  13 January 2017

D. Woodrow Benson  and
Mitchell I. Cohen
D. Woodrow Benson
Affiliation:
Congenital & Pediatric Cardiac Research, Department of Pediatrics, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, United States of America
Mitchell I. Cohen*
Affiliation:
Heart Center, Department of Pediatric Cardiology, Phoenix Children’s Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, United States of America
*
Correspondence to: M. I. Cohen, MD, FACC, FHRS, Heart Center, Pediatric Cardiology, Phoenix Children’s Hospital, University of Arizona College of Medicine-Phoenix, 1919 E. Thomas Road, 2nd Floor, Heart Center, Phoenix, AZ 85016, United States of America. Tel: 602 933 3366; Fax: 602 933 4166; E-mail: mitchcohenmd@gmail.com
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Abstract

The Wolff–Parkinson–White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope – the “delta wave”. It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation <250 ms. Owing to the relatively high prevalence of asymptomatic Wolff–Parkinson–White pattern and availability of catheter ablation, there has been a need to identify risk among asymptomatic patients. Recent guidelines recommend invasive evaluation for such patients where pre-excitation clearly does not disappear during exercise testing. This strategy has a high negative predictive value only. The accuracy of this approach is under continued investigation, especially in light of other considerations: Patients having intermittent pre-excitation, once thought to be at minimal risk may not be, and the role of isoproterenol in risk assessment.

Keywords

Wolff–Parkinson–Whitesudden deathatrial fibrillation
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Supplement S1: Sudden Cardiac Arrest in the Young: A Contemporary Perspective , January 2017 , pp. S62 - S67
Copyright
© Cambridge University Press 2017 

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