Wolff-Parkinson-White syndrome natural history
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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 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.
Symptomatic patients are at risk of the following complication include:
- Reduced blood pressure and syncope
- Tachycaria induced cardiomayopathy
- Cardiac arrest
- Ventricular fibrillation
- Sudden cardiac death
- Complications of ablation
- Side effects of medications
- Cause of SCD in WPW syndrome is the rapid conduction of atrial fibrillation (heart rate >240/min) to the ventricles via the accessory bypass tract causing ventricular fibrillation.
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.
- 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
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.
- ↑ 4.0 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.