Wolff-Parkinson-White syndrome risk stratification: Difference between revisions
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{{Wolff-Parkinson-White syndrome}} | {{Wolff-Parkinson-White syndrome}} | ||
{{CMG}}; | {{CMG}}; {{AE}} {{Sara.Zand}} {{CZ}} | ||
==Overview== | ==Overview== | ||
Treatment is based on risk stratification of the individual. Risk stratification is performed to determine which individuals with WPW syndrome are at risk for sudden cardiac death (SCD). | Treatment is based on the risk stratification of the individual. Risk stratification is performed to determine which individuals with [[WPW syndrome]] are at risk for [[sudden cardiac death]] (SCD). [[Sudden cardiac death]] in these individuals is due to the propagation of an [[atrial arrhythmia]] to the [[ventricles]] at a very high rate. Noninvasive tests have a 70% [[positive predictive value]] and 30% [[negative predictive value]] for identifying [[pathways]] with [[life-threatening]] properties.[[ Electrophysiologic studies]] are useful for evaluation of patients' [[symptoms]]. | ||
==Risk Stratification== | |||
:*Low-risk patients for life-threatening arrhythmia over the [[accessory pathway]] during [[AF]] include the following:<ref name="PageJoglar2016">{{cite journal|last1=Page|first1=Richard L.|last2=Joglar|first2=José A.|last3=Caldwell|first3=Mary A.|last4=Calkins|first4=Hugh|last5=Conti|first5=Jamie B.|last6=Deal|first6=Barbara J.|last7=Estes III|first7=N.A. Mark|last8=Field|first8=Michael E.|last9=Goldberger|first9=Zachary D.|last10=Hammill|first10=Stephen C.|last11=Indik|first11=Julia H.|last12=Lindsay|first12=Bruce D.|last13=Olshansky|first13=Brian|last14=Russo|first14=Andrea M.|last15=Shen|first15=Win-Kuang|last16=Tracy|first16=Cynthia M.|last17=Al-Khatib|first17=Sana M.|title=2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia|journal=Heart Rhythm|volume=13|issue=4|year=2016|pages=e136–e221|issn=15475271|doi=10.1016/j.hrthm.2015.09.019}}</ref> | |||
*Abrupt loss of conduction over the pathway during [[ exercise test]] in [[sinus rhythm]] | |||
*Intermittent loss of preexcitation during [[EKG]] or [[ambulatory monitoring]] | |||
High risk | :*High-risk patients for life-threatening arrhythmia in the [[electrophysiologic study]] include the following: | ||
* [[R-R interval]]<250 ms between two pre-excited complexes during induced [[ AF]] | |||
* The presence of multiple [[accessory pathways]] | |||
* The finding of [[AVRT]] precipitating pre-excited [[AF]] | |||
* [[Accessory pathway]] refractory period<240 ms | |||
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==References== | ==References== | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Disease]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 10:38, 15 September 2020
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Wolff-Parkinson-White syndrome Microchapters |
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Differentiating Wolff-Parkinson-White syndrome from other Diseases |
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Wolff-Parkinson-White syndrome risk stratification On the Web |
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Wolff-Parkinson-White syndrome risk stratification in the news |
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Risk calculators and risk factors for Wolff-Parkinson-White syndrome risk stratification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]
Overview
Treatment is based on the risk stratification of the individual. Risk stratification is performed to determine which individuals with WPW syndrome are at risk for sudden cardiac death (SCD). Sudden cardiac death in these individuals is due to the propagation of an atrial arrhythmia to the ventricles at a very high rate. Noninvasive tests have a 70% positive predictive value and 30% negative predictive value for identifying pathways with life-threatening properties.Electrophysiologic studies are useful for evaluation of patients' symptoms.
Risk Stratification
- Low-risk patients for life-threatening arrhythmia over the accessory pathway during AF include the following:[1]
- Abrupt loss of conduction over the pathway during exercise test in sinus rhythm
- Intermittent loss of preexcitation during EKG or ambulatory monitoring
- High-risk patients for life-threatening arrhythmia in the electrophysiologic study include the following:
- R-R interval<250 ms between two pre-excited complexes during induced AF
- The presence of multiple accessory pathways
- The finding of AVRT precipitating pre-excited AF
- Accessory pathway refractory period<240 ms
References
- ↑ Page, Richard L.; Joglar, José A.; Caldwell, Mary A.; Calkins, Hugh; Conti, Jamie B.; Deal, Barbara J.; Estes III, N.A. Mark; Field, Michael E.; Goldberger, Zachary D.; Hammill, Stephen C.; Indik, Julia H.; Lindsay, Bruce D.; Olshansky, Brian; Russo, Andrea M.; Shen, Win-Kuang; Tracy, Cynthia M.; Al-Khatib, Sana M. (2016). "2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia". Heart Rhythm. 13 (4): e136–e221. doi:10.1016/j.hrthm.2015.09.019. ISSN 1547-5271.