From the Guidelines
Wolff-Parkinson-White (WPW) syndrome is a heart condition that causes an extra electrical pathway between the heart's upper and lower chambers, resulting in a rapid heartbeat (tachycardia) and potentially life-threatening complications, including sudden cardiac death, particularly if atrial fibrillation develops 1.
Key Characteristics of WPW Syndrome
- The accessory pathway, known as the Bundle of Kent, bypasses the normal electrical conduction system, allowing electrical signals to travel through the heart more quickly than normal.
- This creates a "pre-excitation" pattern on an electrocardiogram (ECG), characterized by a shortened PR interval and a delta wave.
- WPW can cause episodes of rapid heart rate, palpitations, dizziness, shortness of breath, and occasionally fainting.
Risks and Complications
- In rare cases, WPW can lead to sudden cardiac death, particularly if atrial fibrillation develops, with a 10-year risk ranging from 0.15% to 0.24% 1.
- Increased risk of sudden cardiac death is associated with a history of symptomatic tachycardia, multiple accessory pathways, and a shortest pre-excited R-R interval of <250 ms during AF 1.
Treatment Options
- Treatment options include medication (such as beta-blockers or calcium channel blockers), cardioversion for acute episodes, and catheter ablation, which destroys the abnormal pathway and is often curative 1.
- Ablation is recommended in patients with WPW syndrome resuscitated from sudden cardiac arrest due to AF and rapid conduction over the accessory pathway causing VF, and should be considered in patients with WPW syndrome who are symptomatic and/or who have accessory pathways with refractory periods ≤240 ms in duration 1.
From the Research
WPW Syndrome Description
- Wolff-Parkinson-White (WPW) syndrome is a rare abnormal condition frequently associated with paroxysmal supraventricular tachycardia (PSVT) and is described as an arrhythmia under the form of increased heartbeat 2.
Effects of WPW Syndrome
- WPW syndrome can cause increased heartbeat, leading to various symptoms and complications 2.
Treatment of WPW Syndrome
- The management of WPW syndrome in children should begin with the use of a beta-blocker, with the addition of digoxin or procainamide for treatment failures 3.
- For failures to conventional agents, flecainide is the preferred agent, while therapy with propafenone, amiodarone, and sotalol remains to be elucidated 3.
Associated Conditions
- WPW syndrome can be associated with heart or inflammatory conditions, making treatment more challenging 2.
Treatment Challenges
- The unknown causes of WPW syndrome, together with the different responses to treatment in each patient, make it difficult to establish the best therapeutic approach 2.
- Controlled trials regarding the use of new antiarrhythmic agents are available, but the variance in dosing schemes, presence of structural heart disease, and patient age make the development of recommendations difficult 3.