Wolff-Parkinson-White syndrome natural history: Difference between revisions
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*Most patients with this condition never experience symptoms associated with the [[accessory pathway]], nevertheless, symptomatic patients are at risk of the following: | *Most patients with this condition never experience symptoms associated with the [[accessory pathway]], nevertheless, symptomatic patients are at risk of the following: | ||
*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> | *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> | ||
* Reduced blood pressure (caused by continous rapid heart rate) | *Reduced blood pressure (caused by continous rapid heart rate) | ||
* [[Tachycaria]] induced [[cardiomayopathy]] | *[[Tachycaria]] induced [[cardiomayopathy]] | ||
* [[Cardiac arrest]] | *[[Cardiac arrest]] | ||
* [[Ventricular fibrillation]] | *[[Ventricular fibrillation]] | ||
* [[Sudden cardiac death]] | *[[Sudden cardiac death]] | ||
** Cause of [[SCD]] in [[WPW]] syndrome is the rapid conduction of [[atrial fibrillation]] to the ventricles via the accessory bypass tract causing [[ventricular fibrillation]]. | ** 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]]. | ** [[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]]. | ||
Revision as of 14:41, 6 September 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
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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 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:
- Possible complications include:[3]
- Reduced blood pressure (caused by continous rapid heart rate)
- Tachycaria induced cardiomayopathy
- Cardiac arrest
- Ventricular fibrillation
- Sudden cardiac death
- 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. [4]
- Atrial flutter
- Family history of sudden death
- Multiple bypass tracts
- Short accessory pathway refractory periods
- Complications of surgery
- Side effects of medications
Prognosis
- Asymptomatic patients and appropriately treated WPW syndrome have 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 prevents future supraventricular tachyarrhythmia.
Factors associated with a worse prognosis include:
- A family history of sudden cardiac death
- Symptomatic tachyarrhythmia
- Cardiac arrest
- Even these 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.
References
- ↑ 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.
- ↑ 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.
- ↑ "Wolff-Parkinson-White syndrome - National Library of Medicine - PubMed Health". Retrieved 14 April 2014.
- ↑ "Sudden Cardiac Death". Retrieved 14 April 2014.