From the Guidelines
Patients with Wolff-Parkinson-White (WPW) syndrome should undergo catheter ablation as the first-line therapy, especially those with a high risk of sudden cardiac death (SCD), as it is the most effective treatment to eliminate the risk of SCD. WPW syndrome is a heart condition characterized by an abnormal electrical pathway that can cause rapid heartbeat, and it can be associated with a risk of SCD due to the potential for rapid anterograde conduction during atrial fibrillation (AF) 1. The risk of SCD is increased in patients with a shortest pre-excited R-R interval of <250 ms during AF, a history of symptomatic tachycardia, multiple accessory pathways, and Ebstein’s anomaly 1.
The management of WPW syndrome involves:
- Catheter ablation to eliminate the abnormal electrical pathway, which is the most effective treatment to prevent SCD 1
- Medications such as beta-blockers or calcium channel blockers to control symptoms, but these are not as effective as catheter ablation in preventing SCD 1
- Regular monitoring by a cardiologist to assess the risk of SCD and to evaluate the effectiveness of treatment 1
It is essential to note that the risk of SCD associated with WPW syndrome appears highest in the first 2 decades of life, and patients with a high risk of SCD should be considered for catheter ablation as the first-line therapy 1. Additionally, patients who have survived SCD due to WPW syndrome should undergo urgent catheter ablation to eliminate the risk of recurrent SCD 1.
In terms of specific patient populations, athletes with WPW syndrome are at an increased risk of SCD, and pre-participation screening is essential to identify those at high risk 1. The screening should focus on inheritable cardiomyopathies and channelopathies in young athletes, and on coronary artery disease in older athletes 1.
Overall, the management of WPW syndrome should prioritize the prevention of SCD, and catheter ablation is the most effective treatment to achieve this goal.
From the Research
Wolff-Parkinson-White Syndrome
- The Wolff-Parkinson-White (WPW) syndrome is a condition characterized by the presence of an accessory electrical pathway between the atria and ventricles, which can cause rapid heart rhythms and increase the risk of sudden cardiac death 2, 3.
- The diagnosis of WPW syndrome is typically made based on electrocardiographic features, including a short PR interval, a delta wave, and a widened QRS complex 4.
- The management of WPW syndrome depends on the presence and severity of symptoms, as well as the risk of sudden cardiac death 2, 3.
Treatment Options
- Medications such as antiarrhythmic agents (e.g. flecainide, propafenone) and beta-blockers (e.g. atenolol, nadolol) may be used to control symptoms and prevent rapid heart rhythms 3, 5.
- Catheter ablation is a procedure that uses radiofrequency energy to destroy the accessory pathway and is often considered the most effective treatment for WPW syndrome 2, 5.
- Surgical ablation may be considered in cases where catheter ablation is not feasible or has failed 5.
Risks and Complications
- Patients with WPW syndrome are at risk of developing atrial fibrillation, which can increase the risk of sudden cardiac death 2, 3.
- The risk of sudden cardiac death is higher in patients with WPW syndrome who have a history of rapid heart rhythms or who have underlying heart disease 3, 6.
- The use of certain medications, such as digitalis, can increase the risk of sudden cardiac death in patients with WPW syndrome 6.