Wolff-Parkinson-White syndrome risk stratification

Jump to: navigation, search

Wolff-Parkinson-White syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Differentiating Wolff-Parkinson-White syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Approach

History and Symptoms

Electrocardiogram

EKG Examples

Other Diagnostic Studies

Treatment

Risk Stratification

Cardioversion

Medical Therapy

Catheter Ablation

Prophylaxis

Consensus Statement

Case Studies

Case #1

Wolff-Parkinson-White syndrome risk stratification On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Wolff-Parkinson-White syndrome risk stratification

CDC onWolff-Parkinson-White syndrome risk stratification

Wolff-Parkinson-White syndrome risk stratification in the news

Blogs on Wolff-Parkinson-White syndrome risk stratification

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Wolff-Parkinson-White syndrome risk stratification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Treatment is based on risk stratification of the individual. Risk stratification is performed to determine which individuals with WPW syndrome are at risk for sudden cardiac death (SCD). Sudden cardiac death in these individuals is due to the propagation of an atrial arrhythmia to the ventricles at a very high rate.

Risk Stratification

A good history should be taken to determine whether an individual has factors suggestive of a previous episode of unexplained syncope (fainting) or palpitations (sudden awareness of one's own, usually irregular, heartbeat). These may be due to earlier episodes of a tachycardia associated with the accessory pathway.

Individuals with WPW syndrome in whom the delta waves disappear with increases in the heart rate are considered at lower risk of SCD. This is because the loss of the delta wave shows that the accessory pathway cannot conduct electrical impulses at a high rate (in the anterograde direction). These individuals will typically not have fast conduction down the accessory pathway during episodes of atrial fibrillation.

Risk stratification is best performed via programmed electrical stimulation (PES) in the cardiac electrophysiology lab. This is an invasive procedure, in which the rate of impulse propagation via the accessory pathway is determined by stimulating the atria and by inducing transient atrial fibrillation.

High risk features that may be present during PES include an effective refractory period of the accessory pathway less than 270 ms, multiple pathways, septal location of pathway, and inducibility of supraventricular tachycardia. Individuals with any of these high risk features are generally considered at increased risk for SCD and should be treated accordingly.[1]

It is unclear whether invasive risk stratification (with programmed electrical stimulation) is necessary in the asymptomatic individual.[2] While some groups advocate PES for risk stratification in all individuals under 35 years old, others only offer it to individuals who have history suggestive of a tachyarrhythmia, since the incidence of sudden death is so low.

References

  1. Pappone C, Santinelli V, Manguso F, Augello G, Santinelli O, Vicedomini G, Gulletta S, Mazzone P, Tortoriello V, Pappone A, Dicandia C, Rosanio S. (2003). "A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome" (free registration required). New England Journal of Medicine. 349 (19): 1803–11. PMID 14602878.
  2. Campbell RM, Strieper MJ, Frias PA, Collins KK, Van Hare GF, Dubin AM (2003). "Survey of current practice of pediatric electrophysiologists for asymptomatic Wolff-Parkinson-White syndrome". Pediatrics. 111 (3): e245–7. PMID 12612279.



Linked-in.jpg