Wolff-Parkinson-White syndrome consensus statement

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Kashish Goel, M.D.

PACES/HRS Expert Consensus - Recommendations for Risk Stratification (DO NOT EDIT)


Class IIa

1. An exercise stress test, when the child is old enough to comply, is a reasonable component of the evaluation if the ambulatory ECG exhibits persistent preexcitation (Level of Evidence: B/Level of Evidence: C). In patients with clear and abrupt loss of preexcitation at physiological heart rates, the accessory pathway properties pose a lower risk of sudden death. In children with subtle preexcitation the ECG and exercise test may be difficult to interpret.

2. Utilization of invasive risk stratification (transesophageal or intracardiac) to assess the shortest preexcited R-R interval in atrial fibrillation is reasonable in individuals whose noninvasive testing does not demonstrate clear and abrupt loss of preexcitation.(Level of Evidence: B/Level of Evidence: C)

PACES/HRS Expert Consensus - Recommendations for Catheter Ablation (DO NOT EDIT)


Class IIa

3. Young patients with a Shortest Pre-Excited R-R Interval (SPERRI) ≤250 ms in atrial fibrillation are at increased risk for sudden cardiac death (SCD). It is reasonable to consider catheter ablation in this group, taking into account the procedural risk factors based on the anatomical location of the pathway. (Level of Evidence: B/Level of Evidence: C)

4. Young patients with a SPERRI >250 ms in atrial fibrillation are at lower risk for SCD, and it is reasonable to defer ablation. (Level of Evidence: C) Ablation may be considered in these patients at the time of diagnostic study if the location of the pathway and/or patient characteristics do not suggest that ablation may incur an increased risk of adverse events, such as AV block or coronary artery injury (Class IIB, Level of Evidence: C)

5. Young patients deemed to be at low risk might subsequently develop cardiovascular symptoms such as syncope or palpitations. These patients should then be considered symptomatic and may be eligible for catheter ablation procedures regardless of the prior assessment.

Class IIb

6. Asymptomatic patients with a WPW ECG pattern and structural heart disease are at risk for both atrial tachycardia and AV reciprocating tachycardia, which may result in unfavorable hemodynamics. Ablation may be considered regardless of the anterograde characteristics of the accessory pathway. '(Level of Evidence: C).

7. Asymptomatic patients with a WPW ECG pattern and ventricular dysfunction secondary to dyssynchronous contractions may be considered for ablation, regardless of anterograde characteristics of the bypass tract. '(Level of Evidence: C).

PACES/HRS Expert Consensus - Special Considerations (DO NOT EDIT)


8. Asymptomatic patients with a WPW ECG pattern may be prescribed ADHD medications. This recommendation follows the American Heart Association Guidelines, which state that ADHD medications may be used in this setting after cardiac evaluation and with intermittent monitoring and supervision of a pediatric cardiologist.[2]


  1. 1.0 1.1 1.2 Cohen MI, Triedman JK, Cannon BC; 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. doi:10.1016/j.hrthm.2012.03.050. PMID 22579340. Unknown parameter |month= ignored (help)
  2. Vetter VL, Elia J, Erickson C; et al. (2008). "Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing". Circulation. 117 (18): 2407–23. doi:10.1161/CIRCULATIONAHA.107.189473. PMID 18427125. Unknown parameter |month= ignored (help)