Wolff-Parkinson-White syndrome natural history: Difference between revisions
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==Natural History== | ==Natural History== | ||
[[Wolff-Parkinson-White syndrome]] can be either asymptomatic or symptomatic, being the first one the most common presentation. As it is difficult to evaluate asymptomatic patients, most information about the natural history of this 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> | [[Wolff-Parkinson-White syndrome]] can be either asymptomatic or symptomatic, being the first one the most common presentation. As it is difficult to evaluate asymptomatic patients, most information about the natural history of this 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 lifes, nearly 65% of adolescents and 40% of adults present ECG changes but remain asymptomatic. Nevertheless, sudden death can be the form of presentation in patients with this condition.<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== | ||
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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, being the first one the most common presentation. As it is difficult to evaluate asymptomatic patients, most information about the natural history of this patients has been taken from symptomatic patients.[1] Patients with WPW pattern can remain asymptomatic through all their lifes, nearly 65% of adolescents and 40% of adults present ECG changes but remain asymptomatic. Nevertheless, sudden death can be the form of presentation in patients with this condition.[2]
Complications
Complications of Wolff-Parkinson-White syndrome can occur at any age, although some individuals born with an accessory pathway in the heart never experience any health problems associated with the condition.
Possible complications include:
- Reduced blood pressure (caused by continous rapid heart rate)
- Heart failure
- Cardiac arrest
- Ventricular fibrillation: It may rapidly lead to shock, and requires emergency treatment (cardioversion).
- 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. Incidence is nearly 1000 per 100,000 symptomatic cases. In as many as 4.5% of the cases it can be the initial presentation. The risk is more even in the asymptomatic patient population when compared to the general population. Factors that influence the occurrence of SCD are:
- Atrial fibrillation: It can be very dangerous, as the presence of an accessory tract from atria to ventricles transmits all the atrial signals to the ventricles bypassing the AV node causing the ventricles to beat at a very fast rate making the heart inefficient to pump blood effectively. There are very high chances of ventricular fibrillation also.
- Atrial flutter
- Family history of premature sudden death
- Multiple bypass tracts
- Short accessory pathway refractory periods
- Complications of surgery
- Side effects of medications
Prognosis
Appropriately treated WPW syndrome has an excellent prognosis. Catheter ablation (radiofrequency ablation) cures this disorder in most patients. The success rate for the procedure ranges between 85 - 95%. Success rate varies depending on location of accessory pathway and number of accessory pathways. Successful ablation also prevents future SVT. Asymptomatic patients (Wolf-Parkinson-White pattern) have a very good prognosis.
Factors associated with worse prognosis include:
- A family history of sudden cardiac death
- Significant symptoms of tachyarrhythmias
- Cardiac arrest
Even these patients with worse prognosis regain good prognosis with timely and appropriate treatment using radiofrequecy ablation. Over all 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.