Wolff–Parkinson–White syndrome

Wolff–Parkinson–White syndrome
Other namesWPW pattern, Ventricular pre-excitation with arrhythmia, auriculoventricular accessory pathway syndrome[1][2]
Conduction through the accessory pathway results in a delta wave.
A characteristic "delta wave" (arrow) seen in a person with Wolff–Parkinson–White syndrome. Note the short PR interval.
SpecialtyCardiology
SymptomsAbnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, loss of consciousness[1][2]
ComplicationsCardiomyopathy, stroke, sudden cardiac death[2]
Usual onsetBirth[1]
CausesAccessory pathway in the heart[1]
Diagnostic methodElectrocardiogram shows a short PR interval and a wide QRS complex from a delta wave[3]
TreatmentWatchful waiting, medications, radiofrequency catheter ablation[4][5]
PrognosisWithout symptoms 0.5% (children), 0.1% (adults) risk of death per year[5]
Frequency0.2%[1]

Wolff–Parkinson–White syndrome (WPWS) is a disorder due to a specific type of problem with the electrical system of the heart involving an accessory pathway able to conduct electrical current between the atria and the ventricles, thus bypassing the atrioventricular node.[2][3] About 60% of people with the electrical problem develop symptoms,[5] which may include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope.[1] Rarely, cardiac arrest may occur.[1] The most common type of arrhythmia (abnormal heart rate) associated with WPWS is paroxysmal supraventricular tachycardia.[1]

The cause of WPW is typically unknown and is likely due to a combination of chance and genetic factors.[2] A small number of cases are due to a mutation of the PRKAG2 gene which may be inherited in an autosomal dominant fashion.[2] The underlying mechanism involves an accessory electrical conduction pathway between the atria and the ventricles.[1] It is associated with other conditions such as Ebstein anomaly and hypokalemic periodic paralysis.[1] The diagnosis of WPW occurs with a combination of palpitations and when an electrocardiogram (ECG) show a short PR interval and a delta wave.[3] It is a type of pre-excitation syndrome.[3]

WPW syndrome may be monitored or treated with either medications or an ablation (destroying the tissues) such as with radiofrequency catheter ablation.[4] It affects between 0.1 and 0.3% in the population.[1] The risk of death in those without symptoms is about 0.5% per year in children and 0.1% per year in adults.[5] In some cases, non-invasive monitoring may help to more carefully risk stratify patients into a lower risk category.[6] In those without symptoms ongoing observation may be reasonable.[5] In those with WPW complicated by atrial fibrillation, cardioversion or the medication procainamide may be used.[7] The condition is named after Louis Wolff, John Parkinson, and Paul Dudley White who described the ECG findings in 1930.[3]

  1. ^ a b c d e f g h i j k "Wolff-Parkinson-White syndrome". Genetics Home Reference. U.S. National Library of Medicine. March 2017. Archived from the original on 27 April 2017. Retrieved 30 April 2017.
  2. ^ a b c d e f "Wolff-Parkinson-White syndrome". rarediseases.info.nih.gov. 31 December 2012. Archived from the original on 21 April 2017. Retrieved 30 April 2017.
  3. ^ a b c d e Bhatia A, Sra J, Akhtar M (March 2016). "Preexcitation Syndromes". Current Problems in Cardiology. 41 (3): 99–137. doi:10.1016/j.cpcardiol.2015.11.002. PMID 26897561.
  4. ^ a b Liu A, Pusalkar P (June 2011). "Asymptomatic Wolff-Parkinson-White syndrome: incidental ECG diagnosis and a review of literature regarding current treatment". BMJ Case Reports. 2011: bcr0520114192. doi:10.1136/bcr.05.2011.4192. PMC 3128358. PMID 22693197.
  5. ^ a b c d e Kim SS, Knight BP (May 2017). "Long term risk of Wolff-Parkinson-White pattern and syndrome". Trends in Cardiovascular Medicine. 27 (4): 260–268. doi:10.1016/j.tcm.2016.12.001. PMID 28108086.
  6. ^ "Wolff-Parkinson-White Syndrome Clinic". UWHealthkids.org. University of Wisconsin Hospitals and Clinics. 29 March 2019. Archived from the original on 30 November 2020. Retrieved 22 March 2021.
  7. ^ Cite error: The named reference Sim2010 was invoked but never defined (see the help page).
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