Wolff-Parkinson-White syndrome natural history

Wolff-Parkinson-White syndrome Microchapters
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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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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. 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 asymptomatic patients compared to the general population. Factors that influence the occurrence of SCD are:
  • Atrial fibrillation

• • 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.