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{{Wolff-Parkinson-White syndrome}}
{{Wolff-Parkinson-White syndrome}}
{{CMG}}; {{AE}} {{RT}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{RT}}


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==Overview==
Patients with [[WPW]] pattern can remain asymptomatic through all their lives, nearly 65% of adolescents and 40% of adults present [[ECG]] changes but remain asymptomatic. Complications Wolff-Parkinson-White syndrome is a consequence of symptomatic [[tachycardias]] and can occur at any age. Common complications of tachyarrhythmia associated [[WPW]] disease include reduced [[blood pressure]] and [[syncope]], [[tachycaria]] induced [[cardiomyopathy]], [[cardiac arrest]], [[ventricular fibrillation]], [[usdden cardiac death]], complications of [[ablation]], side effects of [[medications]]. [[SCD]] may occur in [[WPW]] syndrome due to rapid conduction of [[atrial fibrillation]] with [[heart rate]] >240/min to the ventricles via the accessory bypass tract leading [[ventricular fibrillation]]. Prognosis is generally excellent in asymptomatic [[WPW]] pattern.
* [[Catheter ablation]] ([[radiofrequency ablation]]) has a success rate between 95 - 98%, which varies depending on the location and number of [[accessory pathways]].
* Successful ablation prevents future [[supraventricular tachyarrhythmia]]. The risk of lethal arrhythmia in asymptomatic children is higher than in adults. Long-term rates of [[atrial fibrillation]] in [[adult]] patients that present with [[WPW ]] remains high despite [[ablation]]. Increased risk of [[atrial fibrillation]] in ablated [[WPW]] patients may be related [[atrial fibrillation]] genesis.
     
==Natural History==
==Natural History==
[[Wolff-Parkinson-White syndrome]] can be either asymptomatic or symptomatic.As it is difficult to evaluate asymptomatic patients, most information about the natural history of these patients has been taken from symptomatic patients.<ref name="pmid22579340">{{cite journal| author=Pediatric and Congenital Electrophysiology Society (PACES). Heart Rhythm Society (HRS). American College of Cardiology Foundation (ACCF). American Heart Association (AHA). American Academy of Pediatrics (AAP). Canadian Heart Rhythm Society (CHRS) et al.| title=PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). | journal=Heart Rhythm | year= 2012 | volume= 9 | issue= 6 | pages= 1006-24 | pmid=22579340 | doi=10.1016/j.hrthm.2012.03.050 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22579340  }} </ref>  Patients with WPW pattern can remain asymptomatic through all their lives, nearly 65% of adolescents and 40% of adults present ECG changes but remain asymptomatic.<ref name="pmid22532593">{{cite journal| author=Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Modi S, Krahn AD et al.| title=Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis. | journal=Circulation | year= 2012 | volume= 125 | issue= 19 | pages= 2308-15 | pmid=22532593 | doi=10.1161/CIRCULATIONAHA.111.055350 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22532593  }} </ref>
[[Wolff-Parkinson-White syndrome]] can be either asymptomatic or symptomatic. As it is difficult to evaluate asymptomatic patients, most information about the natural history of these patients has been taken from symptomatic patients.<ref name="pmid22579340">{{cite journal| author=Pediatric and Congenital Electrophysiology Society (PACES). Heart Rhythm Society (HRS). American College of Cardiology Foundation (ACCF). American Heart Association (AHA). American Academy of Pediatrics (AAP). Canadian Heart Rhythm Society (CHRS) et al.| title=PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). | journal=Heart Rhythm | year= 2012 | volume= 9 | issue= 6 | pages= 1006-24 | pmid=22579340 | doi=10.1016/j.hrthm.2012.03.050 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22579340  }} </ref>  Patients with WPW pattern can remain asymptomatic through all their lives, nearly 65% of adolescents and 40% of adults present ECG changes but remain asymptomatic.<ref name="pmid22532593">{{cite journal| author=Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Modi S, Krahn AD et al.| title=Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis. | journal=Circulation | year= 2012 | volume= 125 | issue= 19 | pages= 2308-15 | pmid=22532593 | doi=10.1161/CIRCULATIONAHA.111.055350 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22532593  }} </ref>


==Complications==
==Complications==
Complications Wolff-Parkinson-White syndrome are a consequence of symptomatic [[tachycardias]] and can occur at any age. Most patients with this condition never experience symptoms associated with the [[accessory pathway]], nevertheless, symptomatic patients are at risk of the following:
* Complications Wolff-Parkinson-White syndrome is a consequence of symptomatic [[tachycardias]] and can occur at any age.  
 
* Most patients with this condition never experience symptoms associated with the [[accessory pathway]].
Possible complications include:<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Wolff-Parkinson-White syndrome - National Library of Medicine - PubMed Health | url = http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001206/ | publisher =  | date =  | accessdate = 14 April 2014 }}</ref>
Common complications of tachyarrhythmia associated [[WPW]] disease include:
* Reduced [[blood pressure]] and [[syncope]]
*[[Tachycaria]] induced [[cardiomayopathy]]
*[[Cardiac arrest]]
*[[Ventricular fibrillation]]
*[[Sudden cardiac death]]
*Complications of [[ablation]]
* Side effects of [[medications]]                                                                                                                                                                                                                                                                                                                                         


* Reduced blood pressure (caused by continous rapid heart rate)
:* [[SCD]] may occur in [[WPW]] syndrome due to rapid conduction of [[atrial fibrillation]] with [[heart rate]] >240/min to the ventricles via the accessory bypass tract leading [[ventricular fibrillation]].
* [[Heart failure]]
* [[Cardiac arrest]]
* [[Ventricular fibrillation]]: It may rapidly lead to shock, and requires emergency treatment ([[defibrillation]]).
* [[Sudden cardiac death]]: The younger the age of presentation the more is the risk of sudden cardiac death, because of the more active life style.  Cause of SCD in WPW syndrome is the rapid conduction of atrial fibrillation to the ventricles via the accessory bypass tract causing ventricular fibrillation.
:* [[Atrial fibrillation]]: Very dangerous condition, as the [[accessory pathway]] transmits the [[atrial]] impulses to the [[ventricles]] bypassing the [[AV node]] generating high [[ventricular]] rates which can lead to inefficiency to pump blood effectively.  There are very high chances of [[ventricular fibrillation]]. WPW paitnents at high risk of [[sudden cardiac death]] are the ones with a short interval between ventricular rates.                                                                                                                                                                                                                                                                                                          <ref name="circ.ahajournals.org">{{Cite web  | last =  | first =  | title = Sudden Cardiac Death | url = http://circ.ahajournals.org/content/98/21/2334.full.pdf+html | publisher =  | date =  | accessdate = 14 April 2014 }}</ref>                                                                                                                                                                                                                                                                                                                                                         
:* [[Atrial flutter]]
:* Family history of [[sudden death]]
:* Multiple bypass tracts
:* Short accessory pathway refractory periods
* Complications of surgery
* Side effects of medications


==Prognosis==
==Prognosis==
Asymptomatic patients and appropriately treated WPW syndrome has an excellent prognosis. [[Catheter ablation]] ([[radiofrequency ablation]]) has a success rate between 95 - 98%, which varies depending on the location and number of [[accessory pathways]]. Successful ablation also prevents future [[SVT]].
* Prognosis is generally excellent in asymptomatic [[WPW]] pattern.
 
* [[Catheter ablation]] ([[radiofrequency ablation]]) has a success rate between 95 - 98%, which varies depending on the location and number of [[accessory pathways]].
Factors associated with a worse prognosis include:
* Successful ablation prevents future [[supraventricular tachyarrhythmia]].
* A family history of [[sudden cardiac death]]
*Even patients with worse prognosis regain a good prognosis with treatment using radio-frequency ablation.
* Symptomatic [[tachyarrhythmia]]
*The overall risk of [[death]] in patients with [[WPW]] syndrome reaches 0.15% every year.
* [[Cardiac arrest]]
*Patients with WPW pattern can remain asymptomatic through all their lives, nearly 65% of adolescents and 40% of adults present [[ECG]] changes but remain asymptomatic.<ref name="pmid22532593">{{cite journal| author=Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Modi S, Krahn AD et al.| title=Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis. | journal=Circulation | year= 2012 | volume= 125 | issue= 19 | pages= 2308-15 | pmid=22532593 | doi=10.1161/CIRCULATIONAHA.111.055350 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22532593  }} </ref>
 
* The risk of lethal arrhythmia in asymptomatic children is higher than adults.<ref name="pmid24982705">{{cite journal |vauthors=Rao AL, Salerno JC, Asif IM, Drezner JA |title=Evaluation and management of wolff-Parkinson-white in athletes |journal=Sports Health |volume=6 |issue=4 |pages=326–32 |date=July 2014 |pmid=24982705 |pmc=4065555 |doi=10.1177/1941738113509059 |url=}}</ref>
Even these patients with worse prognosis regain good prognosis with timely and appropriate treatment using radiofrequecy ablation. Overall risk of death in patients with WPW syndrome reaches 0.15% every year.
*Long-term mortality in adult patients with [[WPW]] syndrome is low and similar to control patients without [[ WPW]].<ref name="BunchMay2015">{{cite journal|last1=Bunch|first1=T. Jared|last2=May|first2=Heidi T.|last3=Bair|first3=Tami L.|last4=Anderson|first4=Jeffrey L.|last5=Crandall|first5=Brian G.|last6=Cutler|first6=Michael J.|last7=Jacobs|first7=Victoria|last8=Mallender|first8=Charles|last9=Muhlestein|first9=Joseph B.|last10=Osborn|first10=Jeffrey S.|last11=Weiss|first11=J. Peter|last12=Day|first12=John D.|title=Long-Term Natural History of Adult Wolff–Parkinson–White Syndrome Patients Treated With and Without Catheter Ablation|journal=Circulation: Arrhythmia and Electrophysiology|volume=8|issue=6|year=2015|pages=1465–1471|issn=1941-3149|doi=10.1161/CIRCEP.115.003013}}</ref>
* Long-term rates of [[atrial fibrillation]] in [[adult]] patients that present with [[WPW ]] remains high despite [[ablation]].<ref name="BunchMay2015">{{cite journal|last1=Bunch|first1=T. Jared|last2=May|first2=Heidi T.|last3=Bair|first3=Tami L.|last4=Anderson|first4=Jeffrey L.|last5=Crandall|first5=Brian G.|last6=Cutler|first6=Michael J.|last7=Jacobs|first7=Victoria|last8=Mallender|first8=Charles|last9=Muhlestein|first9=Joseph B.|last10=Osborn|first10=Jeffrey S.|last11=Weiss|first11=J. Peter|last12=Day|first12=John D.|title=Long-Term Natural History of Adult Wolff–Parkinson–White Syndrome Patients Treated With and Without Catheter Ablation|journal=Circulation: Arrhythmia and Electrophysiology|volume=8|issue=6|year=2015|pages=1465–1471|issn=1941-3149|doi=10.1161/CIRCEP.115.003013}}</ref>
*Increased risk of [[atrial fibrillation]] in ablated [[WPW]] patients may be related [[atrial fibrillation]] genesis.<ref name="BunchMay2015">{{cite journal|last1=Bunch|first1=T. Jared|last2=May|first2=Heidi T.|last3=Bair|first3=Tami L.|last4=Anderson|first4=Jeffrey L.|last5=Crandall|first5=Brian G.|last6=Cutler|first6=Michael J.|last7=Jacobs|first7=Victoria|last8=Mallender|first8=Charles|last9=Muhlestein|first9=Joseph B.|last10=Osborn|first10=Jeffrey S.|last11=Weiss|first11=J. Peter|last12=Day|first12=John D.|title=Long-Term Natural History of Adult Wolff–Parkinson–White Syndrome Patients Treated With and Without Catheter Ablation|journal=Circulation: Arrhythmia and Electrophysiology|volume=8|issue=6|year=2015|pages=1465–1471|issn=1941-3149|doi=10.1161/CIRCEP.115.003013}}</ref>


==References==
==References==

Latest revision as of 20:14, 9 November 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Raviteja Guddeti, M.B.B.S. [3]

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Overview

Patients with WPW pattern can remain asymptomatic through all their lives, nearly 65% of adolescents and 40% of adults present ECG changes but remain asymptomatic. Complications Wolff-Parkinson-White syndrome is a consequence of symptomatic tachycardias and can occur at any age. Common complications of tachyarrhythmia associated WPW disease include reduced blood pressure and syncope, tachycaria induced cardiomyopathy, cardiac arrest, ventricular fibrillation, usdden cardiac death, complications of ablation, side effects of medications. SCD may occur in WPW syndrome due to rapid conduction of atrial fibrillation with heart rate >240/min to the ventricles via the accessory bypass tract leading ventricular fibrillation. Prognosis is generally excellent in asymptomatic WPW pattern.

Natural History

Wolff-Parkinson-White syndrome can be either asymptomatic or symptomatic. As it is difficult to evaluate asymptomatic patients, most information about the natural history of these patients has been taken from symptomatic patients.[1] Patients with WPW pattern can remain asymptomatic through all their lives, nearly 65% of adolescents and 40% of adults present ECG changes but remain asymptomatic.[2]

Complications

  • Complications Wolff-Parkinson-White syndrome is a consequence of symptomatic tachycardias and can occur at any age.
  • Most patients with this condition never experience symptoms associated with the accessory pathway.

Common complications of tachyarrhythmia associated WPW disease include:

Prognosis

  • Prognosis is generally excellent in asymptomatic WPW pattern.
  • Catheter ablation (radiofrequency ablation) has a success rate between 95 - 98%, which varies depending on the location and number of accessory pathways.
  • Successful ablation prevents future supraventricular tachyarrhythmia.
  • Even patients with worse prognosis regain a good prognosis with treatment using radio-frequency ablation.
  • The overall risk of death in patients with WPW syndrome reaches 0.15% every year.
  • Patients with WPW pattern can remain asymptomatic through all their lives, nearly 65% of adolescents and 40% of adults present ECG changes but remain asymptomatic.[2]
  • The risk of lethal arrhythmia in asymptomatic children is higher than adults.[3]
  • Long-term mortality in adult patients with WPW syndrome is low and similar to control patients without WPW.[4]
  • Long-term rates of atrial fibrillation in adult patients that present with WPW remains high despite ablation.[4]
  • Increased risk of atrial fibrillation in ablated WPW patients may be related atrial fibrillation genesis.[4]

References

  1. ↑ Pediatric and Congenital Electrophysiology Society (PACES). Heart Rhythm Society (HRS). American College of Cardiology Foundation (ACCF). American Heart Association (AHA). American Academy of Pediatrics (AAP). Canadian Heart Rhythm Society (CHRS); et al. (2012). "PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS)". Heart Rhythm. 9 (6): 1006–24. doi:10.1016/j.hrthm.2012.03.050. PMID 22579340.
  2. ↑ 2.0 2.1 Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Modi S, Krahn AD; et al. (2012). "Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis". Circulation. 125 (19): 2308–15. doi:10.1161/CIRCULATIONAHA.111.055350. PMID 22532593.
  3. ↑ Rao AL, Salerno JC, Asif IM, Drezner JA (July 2014). "Evaluation and management of wolff-Parkinson-white in athletes". Sports Health. 6 (4): 326–32. doi:10.1177/1941738113509059. PMC 4065555. PMID 24982705.
  4. ↑ 4.0 4.1 4.2 Bunch, T. Jared; May, Heidi T.; Bair, Tami L.; Anderson, Jeffrey L.; Crandall, Brian G.; Cutler, Michael J.; Jacobs, Victoria; Mallender, Charles; Muhlestein, Joseph B.; Osborn, Jeffrey S.; Weiss, J. Peter; Day, John D. (2015). "Long-Term Natural History of Adult Wolff–Parkinson–White Syndrome Patients Treated With and Without Catheter Ablation". Circulation: Arrhythmia and Electrophysiology. 8 (6): 1465–1471. doi:10.1161/CIRCEP.115.003013. ISSN 1941-3149.

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