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, being the first one the most common presentation. 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. Nevertheless, sudden death can be the form of presentation in patients with this condition.[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, nevertheless, symptomatic patients are at risk of the following:

Possible complications include:[3]

  • 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 (defibrillation).
  • 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.
  • Atrial fibrillation: Very dangerous condition, as the accessory pathway transmits the atrial impulses to the ventricles bypassing the AV node generating high ventricular rates which can lead to inefficiency to pump blood effectively. There are very high chances of ventricular fibrillation. WPW paitnents at high risk of sudden cardiac death are the ones with a short interval between ventricular rates (≤ Normal 0 21 false false false ES-PE X-NONE X-NONE 250 ms or ≥250 bpm).[4] Normal 0 21 false false false ES-PE X-NONE X-NONE
  • Atrial flutter
  • Family history of premature sudden death
  • Multiple bypass tracts
  • Short accessory pathway refractory periods
  • Complications of surgery
  • Side effects of medications

Prognosis

Asymptomatic patients and appropriately treated WPW syndrome has 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 also prevents future SVT.

Factors associated with worse prognosis include:

Even these patients with worse prognosis regain good prognosis with timely and appropriate treatment using radiofrequecy ablation. Overall risk of death in patients with WPW syndrome reaches 0.15% every year.

References

  1. 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. 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.
  3. "Wolff-Parkinson-White syndrome - National Library of Medicine - PubMed Health". Retrieved 14 April 2014.
  4. "Sudden Cardiac Death". Retrieved 14 April 2014.



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