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 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.
- Symptomatic patients are at risk of the following complication include:[3]
- 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 to the ventricles via the accessory bypass tract causing ventricular fibrillation.
- WPW paitnents at high risk of sudden cardiac death are the ones with a short interval between ventricular rates less than 250 milliseconds. [4]
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.
- 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]
- Long-term mortality in adult patients with WPW syndrome is low and similar to control patients withoutWPW.[5]
- Long-term rates of atrial fibrillation in adult patients that present with WPW remains high despite ablation.[6]
- Increased risk of atrial fibrillation in ablated WPW patients may be related atrial fibrillation genesis.[7]
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.
- ↑ "Wolff-Parkinson-White syndrome - National Library of Medicine - PubMed Health". Retrieved 14 April 2014.
- ↑ "Sudden Cardiac Death". Retrieved 14 April 2014.
- ↑ . doi:10.1161/CIRCEP.115.003013Circulation: Arrhythmia and Electrophysiology. 2015;8:1465-1471 Check
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