Can Wolff-Parkinson-White (WPW) syndrome electrocardiogram (ECG) changes resolve over time, particularly following a catheter ablation procedure?

From the Guidelines

Wolf-Parkinson-White (WPW) EKG changes can be permanently eliminated through catheter ablation, which is a highly effective procedure with a success rate of about 95%. The characteristic EKG findings in WPW—a short PR interval, delta wave, and widened QRS complex—are caused by an accessory pathway (bundle of Kent) that allows electrical signals to bypass the normal conduction system.

Key Points

• Catheter ablation is a procedure that specifically targets and destroys this abnormal pathway, effectively curing the condition in about 95% of cases 1.
• After successful ablation, the EKG typically normalizes immediately, with disappearance of the delta wave and normalization of the PR interval and QRS duration.
• This occurs because the abnormal electrical conduction route has been eliminated, forcing the heart's electrical signals to follow only the normal pathway.
• In rare cases, WPW patterns may temporarily disappear and reappear (intermittent WPW), but this is due to temporary conduction block in the accessory pathway rather than permanent resolution of the condition.
• Without ablation, patients typically require lifelong monitoring and possibly medication to manage symptoms and prevent dangerous arrhythmias.

Recommendations

• Catheter ablation of the accessory pathway is recommended in symptomatic patients with AF who have WPW syndrome, particularly those with syncope due to rapid heart rate or those with a short bypass tract refractory period 1.
• Immediate direct-current cardioversion is recommended to prevent ventricular fibrillation in patients with a short anterograde bypass tract refractory period in whom AF occurs with a rapid ventricular response associated with hemodynamic instability 1.
• Intravenous procainamide or ibutilide is recommended to restore sinus rhythm in patients with WPW in whom AF occurs without hemodynamic instability in association with a wide QRS complex on the electrocardiogram (ECG) (greater than or equal to 120-ms duration) or with a rapid preexcited ventricular response 1.

From the Research

WPW Syndrome ECG Changes Resolution

• The resolution of Wolff-Parkinson-White (WPW) syndrome electrocardiogram (ECG) changes over time, particularly following a catheter ablation procedure, is a topic of interest in cardiology.
• According to a study published in 2008 2, catheter ablation has been proven as a very effective and safe therapy for patients with symptomatic WPW syndrome, which may lead to the resolution of ECG changes.
• Another study from 1993 3 describes the use of radiofrequency catheter ablation to prevent further recurrence of tachycardias associated with WPW syndrome, implying that ECG changes may resolve after the procedure.
• A more recent study from 2021 4 reports on the outcomes of ablation in WPW syndrome, stating that catheter ablation is recommended for symptomatic WPW syndrome, and the overall complication rate was 2.5%, which may indicate a resolution of ECG changes in some patients.
• Additionally, a study from 1993 5 discusses the pathophysiology of WPW syndrome and describes medical, surgical, and catheter-based principles, including the use of catheter ablation to resolve ECG changes.
• Furthermore, a study from 2002 6 found that successful accessory pathway ablation prevented cardiac arrest recurrences in resuscitated patients with WPW syndrome, which may imply a resolution of ECG changes.

Catheter Ablation Procedure

• The catheter ablation procedure is considered the first-line therapy for patients with symptomatic WPW syndrome 2, 5.
• The procedure involves the use of radiofrequency energy to ablate the accessory pathway, which can lead to the resolution of ECG changes 3, 4.
• The success rate of the procedure is high, with a low complication rate, as reported in the studies 4, 6.

ECG Changes Resolution

• The resolution of ECG changes in WPW syndrome patients after catheter ablation is not explicitly stated in the provided studies.
• However, the studies suggest that catheter ablation can effectively treat symptomatic WPW syndrome and prevent further recurrence of tachycardias, which may imply a resolution of ECG changes 2, 3, 4, 5, 6.