Materiały źródłowe

• #1 Wolff-Parkinson-White Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that arises from abnormal cardiac electrical conduction through an accessory pathway that can result in symptomatic and life-threatening arrhythmias. The hallmark electrocardiographic (ECG) finding of WPW pattern or preexcitation consists of a short PR interval and prolonged QRS with an initial slurring upstroke (delta wave) in the presence of sinus rhythm. The term WPW syndrome is reserved for an ECG pattern consistent with the above-described findings along with the coexistence of a tachyarrhythmia and clinical symptoms of tachycardia such as palpitations, episodic lightheadedness, presyncope, syncope, or even cardiac arrest. […] WPW pattern is a constellation of electrocardiographic findings, so initial evaluation relies on a surface electrocardiogram. The ECG will show a short PR interval (120 ms), prolonged QRS complex (120 ms), and a QRS morphology consisting of a slurred delta wave. The preexcitation of the ventricle causes this morphology through the accessory pathway that forms a fusion complex with the normal QRS complex arising from normal cardiac conduction. The absence of this pattern does not rule out the presence of an accessory pathway since some pathways are only capable of conducting impulses under certain conditions or in a retrograde direction. Such a pathway could only conduct from the ventricle to the atrium and would not cause ventricular preexcitation during normal sinus beats. This concealed accessory pathway will only be evident on ECG during an electrical impulse generated in the ventricle, such as a premature ventricular contraction or ventricular pacing.

• #2 Wolff-Parkinson-White Syndrome (WPW Syndrome) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/wolff-parkinson-white-syndrome-wpw-syndrome

  Classic (manifest) Wolff-Parkinson-White syndrome is due to an accessory atrioventricular connection that produces a prototypical ECG consisting of a short PR interval, a wide QRS complex with an initial slurred component (delta wave), and secondary repolarization changes in association with symptomatic reentrant (paroxysmal) supraventricular tachycardia. […] Diagnosis is clinical and by electrocardiography. […] Diagnosis of WPW syndrome is by ECG showing a short PR interval (Classic Wolff-Parkinson-White (WPW) Pattern). […] The estimated risk of developing atrial fibrillation in patients with WPW syndrome is 1.5%/year and that of sudden death is 0.1%/year. […] Long-term therapy of patients who have had a documented WPW syndrome-related tachyarrhythmia (or symptoms highly suggestive thereof) is with catheter ablation of the accessory AV connection(s).

• #3 Wolff-Parkinson-White syndrome: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/wolff-parkinson-white-syndrome/

  Wolff-Parkinson-White syndrome affects 1 to 3 in 1,000 people worldwide. […] Wolff-Parkinson-White syndrome is a common cause of an arrhythmia known as paroxysmal supraventricular tachycardia. […] In most cases, the cause of Wolff-Parkinson-White syndrome is unknown. […] Familial Wolff-Parkinson-White syndrome accounts for only a small percentage of all cases of this condition. […] The familial form of the disorder typically has an autosomal dominant pattern of inheritance, which means one copy of the altered gene in each cell is sufficient to cause the condition.

• #4 Wolff-Parkinson-White syndrome (WPW): MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000151.htm

  Wolff-Parkinson-White (WPW) syndrome is a condition in which there is an extra electrical pathway in the heart that leads to periods of rapid heart rate (tachycardia). […] WPW syndrome is one of the most common causes of fast heart rate problems in infants and children. […] A physical exam done during a tachycardia episode will show a heart rate faster than 100 beats per minute. […] If the person is not having tachycardia at the time of the exam, the results may be normal. The condition may be diagnosed with an electrocardiogram (ECG) or with ambulatory ECG monitoring, such as a Holter monitor. […] A test called an electrophysiologic study (EPS) is done using catheters that are placed in the heart. This test may help identify the location of the extra electrical pathway. […] The long-term treatment for WPW syndrome is very often catheter ablation. This procedure involves inserting a tube (catheter) into a vein through a small cut near the groin up to the heart area.

• #5 Wolff-Parkinson-White Syndrome (WPW Syndrome) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/wolff-parkinson-white-syndrome-wpw-syndrome

  Classic (manifest) Wolff-Parkinson-White syndrome is due to an accessory atrioventricular connection that produces a prototypical ECG consisting of a short PR interval, a wide QRS complex with an initial slurred component (delta wave), and secondary repolarization changes in association with symptomatic reentrant (paroxysmal) supraventricular tachycardia. […] Diagnosis is clinical and by electrocardiography. […] Diagnosis of WPW syndrome is by ECG showing a short PR interval (Classic Wolff-Parkinson-White (WPW) Pattern). […] The estimated risk of developing atrial fibrillation in patients with WPW syndrome is 1.5%/year and that of sudden death is 0.1%/year. […] Long-term therapy of patients who have had a documented WPW syndrome-related tachyarrhythmia (or symptoms highly suggestive thereof) is with catheter ablation of the accessory AV connection(s).

• #6 Wolff-Parkinson-White Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that arises from abnormal cardiac electrical conduction through an accessory pathway that can result in symptomatic and life-threatening arrhythmias. The hallmark electrocardiographic (ECG) finding of WPW pattern or preexcitation consists of a short PR interval and prolonged QRS with an initial slurring upstroke (delta wave) in the presence of sinus rhythm. The term WPW syndrome is reserved for an ECG pattern consistent with the above-described findings along with the coexistence of a tachyarrhythmia and clinical symptoms of tachycardia such as palpitations, episodic lightheadedness, presyncope, syncope, or even cardiac arrest. […] WPW pattern is a constellation of electrocardiographic findings, so initial evaluation relies on a surface electrocardiogram. The ECG will show a short PR interval (120 ms), prolonged QRS complex (120 ms), and a QRS morphology consisting of a slurred delta wave. The preexcitation of the ventricle causes this morphology through the accessory pathway that forms a fusion complex with the normal QRS complex arising from normal cardiac conduction. The absence of this pattern does not rule out the presence of an accessory pathway since some pathways are only capable of conducting impulses under certain conditions or in a retrograde direction. Such a pathway could only conduct from the ventricle to the atrium and would not cause ventricular preexcitation during normal sinus beats. This concealed accessory pathway will only be evident on ECG during an electrical impulse generated in the ventricle, such as a premature ventricular contraction or ventricular pacing.

• #7 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  WolfParkinsonWhite (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. […] Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias. […] The diagnosis of WPW syndrome is reserved strictly for patients who have both pre-excitation and symptoms. Identification of WPW patterns in the general population is extremely difficult, as these patients are, by definition, without palpitations, syncope, or other symptoms secondary to ventricular pre-excitation.

• #8 Wolff-Parkinson-White Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/159222-overview

  In 1930, Wolff, Parkinson, and White described a series of young patients who experienced paroxysms of tachycardia and had characteristic abnormalities on electrocardiography (ECG). Currently, Wolff-Parkinson-White (WPW) syndrome is defined as a congenital condition involving abnormal conductive cardiac tissue between the atria and the ventricles that provides a pathway for a reentrant tachycardia circuit, in association with supraventricular tachycardia (SVT). […] The diagnosis of WPW syndrome is typically made with a 12-lead electrocardiogram (ECG) and sometimes with ambulatory monitoring (eg, telemetry, Holter monitoring). SVT is best diagnosed by documenting a 12-lead ECG during tachycardia, although it is often diagnosed with a monitoring strip or even recorder. […] Although the ECG morphology varies widely, the classic ECG features are as follows: A shortened PR interval (typically 120 ms in a teenager or adult), A slurring and slow rise of the initial upstroke of the QRS complex (delta wave), A widened QRS complex (total duration 0.12 seconds), ST segmentT wave (repolarization) changes, generally directed opposite the major delta wave and QRS complex, reflecting altered depolarization.

• #9 Wolff-Parkinson-White Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that arises from abnormal cardiac electrical conduction through an accessory pathway that can result in symptomatic and life-threatening arrhythmias. The hallmark electrocardiographic (ECG) finding of WPW pattern or preexcitation consists of a short PR interval and prolonged QRS with an initial slurring upstroke (delta wave) in the presence of sinus rhythm. The term WPW syndrome is reserved for an ECG pattern consistent with the above-described findings along with the coexistence of a tachyarrhythmia and clinical symptoms of tachycardia such as palpitations, episodic lightheadedness, presyncope, syncope, or even cardiac arrest. […] WPW pattern is a constellation of electrocardiographic findings, so initial evaluation relies on a surface electrocardiogram. The ECG will show a short PR interval (120 ms), prolonged QRS complex (120 ms), and a QRS morphology consisting of a slurred delta wave. The preexcitation of the ventricle causes this morphology through the accessory pathway that forms a fusion complex with the normal QRS complex arising from normal cardiac conduction. The absence of this pattern does not rule out the presence of an accessory pathway since some pathways are only capable of conducting impulses under certain conditions or in a retrograde direction. Such a pathway could only conduct from the ventricle to the atrium and would not cause ventricular preexcitation during normal sinus beats. This concealed accessory pathway will only be evident on ECG during an electrical impulse generated in the ventricle, such as a premature ventricular contraction or ventricular pacing.

• #10 Wolff–Parkinson–White syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Wolff%E2%80%93Parkinson%E2%80%93White_syndrome

  When an individual is in normal sinus rhythm, the ECG characteristics of WPW are a short PR interval (less than 120 milliseconds in duration), widened QRS complex (greater than 120 milliseconds in duration) with slurred upstroke of the QRS complex, and secondary repolarization changes (reflected in ST segment-T wave changes). […] In individuals with WPW, electrical activity that is initiated in the SA node travels through the accessory pathway, as well as through the AV node to activate the ventricles via both pathways. Since the accessory pathway does not have the impulse slowing properties of the AV node, the electrical impulse first activates the ventricles via the accessory pathway, and immediately afterwards via the AV node. This gives the short PR interval and slurred upstroke of the QRS complex known as the delta wave. […] WPW carries a small risk of sudden death, presumably due to rapidly conducted atrial fibrillation causing ventricular fibrillation.

• #11 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  The main electrocardiographic features of pre-excitation are short PR interval (0.12 s), prolonged QRS complex (0.12 s), and slurred, slow-rising onset of the QRS complex, known as delta wave. […] Several algorithms (Chern-En Chiangs, Fitzpatricks, Xies, St Georges, and Pamdruns algorithms) have been used for predicting the accessory pathway location using different electrocardiographic criteria based on the analysis of the delta wave. […] The clinical presentation of WPW syndrome is generally unspecific, extremely variable, and, most importantly, it usually accompanies arrhythmic episodes. […] It is important to acknowledge that AVRT can appear during fetal life (most often between 24 and 32 weeks), representing about 70% of arrhythmias during intrauterine life and being one of the most important causes of heart failure with fetal hydrops.

• #12 Wolff-Parkinson-White syndrome: Diagnostic and management strategies | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/92/2/119

  An unknown number of people are born with single or multiple accessory electrical pathways between the atria and the ventricles. […] Thus, it is imperative to detect the WPW electrocardiographic pattern, diagnose WPW syndrome early, and adequately risk stratify those at risk for serious complications. […] WPW syndrome is a rare congenital cardiac condition in which the patient has single or multiple accessory pathways along the atrioventricular border that predispose them to potentially malignant tachyarrhythmias. […] Here we describe the pathogenesis, diagnostic strategies, general treatment guidelines, and active controversies surrounding management of WPW syndrome. […] An accessory pathway can go undetected until the patient develops symptoms such as palpitations, chest pain, shortness of breath, dizziness, lightheadedness, and syncope associated with arrhythmias. However, surface electrocardiography may reveal the distinctive WPW pattern: a short PR interval ( 120 ms) and the pathognomonic finding of a delta wave, ie, a slurred upstroke of the QRS complex.

• #13 Wolff-Parkinson-White Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that arises from abnormal cardiac electrical conduction through an accessory pathway that can result in symptomatic and life-threatening arrhythmias. The hallmark electrocardiographic (ECG) finding of WPW pattern or preexcitation consists of a short PR interval and prolonged QRS with an initial slurring upstroke (delta wave) in the presence of sinus rhythm. The term WPW syndrome is reserved for an ECG pattern consistent with the above-described findings along with the coexistence of a tachyarrhythmia and clinical symptoms of tachycardia such as palpitations, episodic lightheadedness, presyncope, syncope, or even cardiac arrest. […] WPW pattern is a constellation of electrocardiographic findings, so initial evaluation relies on a surface electrocardiogram. The ECG will show a short PR interval (120 ms), prolonged QRS complex (120 ms), and a QRS morphology consisting of a slurred delta wave. The preexcitation of the ventricle causes this morphology through the accessory pathway that forms a fusion complex with the normal QRS complex arising from normal cardiac conduction. The absence of this pattern does not rule out the presence of an accessory pathway since some pathways are only capable of conducting impulses under certain conditions or in a retrograde direction. Such a pathway could only conduct from the ventricle to the atrium and would not cause ventricular preexcitation during normal sinus beats. This concealed accessory pathway will only be evident on ECG during an electrical impulse generated in the ventricle, such as a premature ventricular contraction or ventricular pacing.

• #14 WPW syndrome: Rare cause of sudden cardiac death in young people – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/wolff-parkinson-white-syndrome/diagnosis-treatment/drc-20354630

  To diagnose Wolff-Parkinson-White (WPW) syndrome, a healthcare professional examines you and listens to your heart with a device called a stethoscope. You usually are asked questions about your medical history and symptoms […] Tests may be done to confirm WPW syndrome and look for an underlying cause. Tests may include: […] An ECG shows how slow or how fast the heart is beating. A healthcare professional can look for heartbeat patterns that suggest an extra electrical pathway in the heart. […] An EP study shows how electrical signals spread through the heart during each heartbeat. […] For WPW syndrome, some basic questions to ask your healthcare team include: What tests do I need? […] Your healthcare professional is likely to ask you questions, such as: How often does the fast heartbeat occur? […] Wolff-Parkinson-White (WPW) syndrome care at Mayo Clinic.

• #15 Wolff-Parkinson-White Syndrome

  https://my.clevelandclinic.org/health/diseases/17643-wolff-parkinson-white-syndrome-wpw

  Wolff-Parkinson-White syndrome is a heart condition that occurs in people born with an extra electrical pathway for heartbeat signals. […] Healthcare providers usually diagnose Wolff-Parkinson-White with an EKG (electrocardiogram). […] Your healthcare provider may recommend certain tests to check your heartbeat, including: Electrocardiogram (EKG). […] Healthcare providers sometimes diagnose WPW syndrome in infants. But a diagnosis is more likely in your teens or early 20s, when symptoms become more noticeable. […] These tests give your healthcare provider information about your heart rate, rhythm and the presence of any signal conduction issues. Your provider can see visible heartbeat differences in a Wolff-Parkinson-White EKG compared to a normal EKG. […] If you experience rapid heartbeat frequently with symptoms like dizziness or passing out, your healthcare provider may recommend: Radiofrequency ablation a type of catheter ablation uses energy to destroy a small amount of heart tissue and restore a regular heartbeat.

• #16 Wolff-Parkinson-White Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/159222-overview

  Echocardiography is needed for the following: Evaluation of left ventricular (LV) function, septal thickness, and wall motion abnormalities, Excluding cardiomyopathy and an associated congenital heart defect (eg, HOCM, Ebstein anomaly, L-transposition of the great vessels). […] Electrophysiologic studies (EPS) can be used in patients with WPW syndrome to determine the following: The mechanism of the clinical tachycardia, The electrophysiologic properties (eg, conduction capability, refractory periods) of the accessory pathway and the normal atrioventricular (AV) nodal and His Purkinje conduction system, The number and locations of accessory pathways (necessary for catheter ablation), The response to pharmacologic or ablation therapy.

• #17 Wolff-Parkinson-White Syndrome | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/wolff-parkinson-white-syndrome

  Wolff-Parkinson-White syndrome may occur spontaneously with unpredictable timing. Therefore, specialized tests may be needed to make an accurate diagnosis. If your doctor suspects that your child has an arrhythmia caused by Wolff-Parkinson-White syndrome, he or she may order one or more of the following diagnostic tests: […] An ECG records the heart’s electrical activity. Small patches called electrodes are placed on your child’s chest, arms and legs, and are connected by wires to the ECG machine. The electrical impulses of your child’s heart are translated into a graph or chart, enabling doctors to determine the pattern of electrical current flow in the heart and to diagnose arrhythmias. […] In an EP study, doctors insert special electrode catheters long, flexible wires into veins and guide them into the heart. These catheters sense electrical impulses and also may be used to stimulate different areas of the heart. Doctors can then locate the sites that are causing arrhythmias. The EP study allows doctors to examine an arrhythmia under controlled conditions and acquire more accurate, detailed information than with any other diagnostic test.

• #18 Patient education: Wolff-Parkinson-White syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/wolff-parkinson-white-syndrome-beyond-the-basics

  Diagnosis of the WPW syndrome is based upon ECG evidence of the accessory pathway and the presence of a related tachycardia. […] In some people, a specialized invasive procedure called electrophysiologic testing or an electrophysiology study may be performed. This test can determine the reason for tachycardia, identify the location of the accessory pathway, and determine if the accessory pathway has dangerous properties.

• #19 Wolff-Parkinson-White Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/159222-overview

  Echocardiography is needed for the following: Evaluation of left ventricular (LV) function, septal thickness, and wall motion abnormalities, Excluding cardiomyopathy and an associated congenital heart defect (eg, HOCM, Ebstein anomaly, L-transposition of the great vessels). […] Electrophysiologic studies (EPS) can be used in patients with WPW syndrome to determine the following: The mechanism of the clinical tachycardia, The electrophysiologic properties (eg, conduction capability, refractory periods) of the accessory pathway and the normal atrioventricular (AV) nodal and His Purkinje conduction system, The number and locations of accessory pathways (necessary for catheter ablation), The response to pharmacologic or ablation therapy.

• #20 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  The most important parameters to be determined during EPT on baseline and (ideally) during catecholamine infusion are those estimating the anterograde conduction over the APs (and therefore the risk for VF), namely the shortest pre-excited RR interval in atrial fibrillation (SPERRI), the accessory pathway effective refractory period (APERP) and the shortest pre-excited paced cycle length during atrial pacing (SPPCL). […] The presence of multiple accessory pathways in conjunction with a SPERRI of less than 250 ms achieved a specificity of 92% and a positive predictive value for future arrhythmic events in 22%.

• #21 Wolff-Parkinson White Syndrome (WPW): Atrio-ventricular Reentry Tachycardia – AF-ABLATION

  https://af-ablation.org/en/arrhythmological-disorders/supraventricular-tachycardia/wolff-parkinson-white-syndrome-wpw-atrio-ventricular-reentry-tachycardia/

  It is important to note that the concept of WPW pattern refers to the presence of ventricular pre-excitation on the surface ECG, while WPW syndrome is the association of WPW patterns with the symptoms due to tachyarrhythmias. Of all patients who show signs of pre-excitation on the surface ECG, only about 50% develop symptoms during their lifetime. Since WPW syndrome is characterized by the association of electrocardiographic changes and arrhythmias, it can be said that only 45-50% of patients who have pre-excitation on the 12-lead ECG suffer from WPW syndrome. […] The electrophysiological study in patients with WPW is useful to confirm the diagnosis, study the mode of initiation of tachycardias, locate the accessory pathways, demonstrate that the accessory pathway participates in the tachycardias, and evaluate the refractory nature of the accessory pathway.

• #22 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  The most important parameters to be determined during EPT on baseline and (ideally) during catecholamine infusion are those estimating the anterograde conduction over the APs (and therefore the risk for VF), namely the shortest pre-excited RR interval in atrial fibrillation (SPERRI), the accessory pathway effective refractory period (APERP) and the shortest pre-excited paced cycle length during atrial pacing (SPPCL). […] The presence of multiple accessory pathways in conjunction with a SPERRI of less than 250 ms achieved a specificity of 92% and a positive predictive value for future arrhythmic events in 22%.

• #23 Management of Wolff-Parkinson-White Syndrome in the Elderly | ECR Journal

  https://www.ecrjournal.com/articles/management-wolff-parkinson-white-syndrome-elderly?language_content_entity=en

  Electrophysiological study is the most reliable method of establishing the prognosis of WPW syndrome. […] WPW syndrome is considered to represent a risk of sudden death when the following association is observed: sustained atrial fibrillation is induced and the shortest respiratory rate (RR) interval between pre-excited beats is less than 250ms in the control state in adults or less than 200ms during isoproterenol infusion. […] The prevalence of a potentially malignant form of WPW syndrome in asymptomatic subjects does not decrease significantly with age. […] Taking into account the possible risks linked to this condition, it is important to carry out investigations such as exercise testing and electrophysiological study for WPW syndrome, irrespective of the age of a subject, even if they are asymptomatic, particularly if the patient continues to exercise or needs to undergo extensive surgery. […] Ablation of the accessory pathway is indicated as soon as the patient becomes symptomatic, but this should be performed carefully due to the difficulty of accessing a left bundle of Kent.

• #24 Wolff-Parkinson-White Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  Recommendations for further evaluation, risk stratification, electrophysiologic study, and accessory pathway ablation for asymptomatic patients with WPW pattern vary depending on age, risk factors, history of symptoms, comorbidities, baseline ECG pattern, as well as a personal and expert opinion. In general, young, healthy patients without comorbid conditions or significant risk factors who have the WPW pattern on ECG but are asymptomatic and without a history of suspected tachyarrhythmia are likely safe for watchful waiting with primary care and or cardiology follow up. […] Patients that present with a symptomatic tachyarrhythmia or an episode concerning recent arrhythmia will require an ECG to assess current cardiac rate, rhythm, and morphology but will also require further evaluation. The patient who presents with an acute tachyarrhythmia can be evaluated and managed following the „2010 American Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.”

• #25 Wolff-Parkinson-White syndrome: Diagnostic and management strategies | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/92/2/119

  A distinction: WPW pattern is diagnosed in patients who have no symptoms but who do have the aforementioned electrocardiographic signs, while a diagnosis of WPW syndrome means the patient has a WPW pattern and symptoms related to arrhythmias caused by the accessory pathway. […] The management challenge lies in those with WPW pattern but no symptoms. […] Catheter ablation has a class I (strong) recommendation in patients who have symptoms and the WPW pattern (WPW syndrome). […] More electrophysiologists now than in the past may be performing electrophysiologic studies in patients with an asymptomatic WPW pattern regardless of noninvasive findings. […] This highlights the importance of careful monitoring and management of patients with WPW pattern and syndrome, given the potential for serious complications even without prior symptoms and high-risk features.

• #26 Wolff-Parkinson White Syndrome (WPW): Atrio-ventricular Reentry Tachycardia – AF-ABLATION

  https://af-ablation.org/en/arrhythmological-disorders/supraventricular-tachycardia/wolff-parkinson-white-syndrome-wpw-atrio-ventricular-reentry-tachycardia/

  An extremely low percentage of patients with WPW suddenly die from ventricular fibrillation. The mechanism is almost certainly an atrial fibrillation with a high ventricular response, which degenerates into a ventricular fibrillation due to the high ventricular rate. This is a dramatic event that can also occur in asymptomatic subjects, with an incidence of 1:1000 subjects per year. It was observed that all patients with pre-excitation who were revived from cardiac arrest had a short antegrade refractory period ( 250 ms) of the accessory pathway. On the basis of these data, it has been proposed to consider patients at risk with this electrophysiological result. However, the positive predictive value of this parameter is very low, since about 20% of subjects subjected to an EP study have these characteristics and should therefore be considered at risk, while the actual incidence of sudden death is considerably lower.

• #27 Wolff Parkinson White Syndrome: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/wolff-parkinson-white-syndrome-diagnosis-and-treatment/

  The presence of intermittent preexcitation has been considered to suggest that the antegrade refractory period of the AP is long, making them very unlikely to mediate a rapid, preexcited ventricular response during atrial fibrillation which is known to be a risk factor for sudden cardiac death. […] Electrophysiology study (EPS) in patients with WPW syndrome can help to confirm the presence of an AP, differentiate this condition from other forms of SVT, and to localize the pathway participating in the tachycardia for ablative therapy. […] Management of patients with AP can vary depending on the symptoms, prognosis, and patients preference. […] The ACC/AHA/ESC Guidelines for Management of Patients with Supraventricular Arrhythmias gives catheter ablation a 2A classification for treatment of patients with asymptomatic preexcitation.

• #28 Diagnosis and therapy in Wolff-Parkinson-White (WPW) syndrome – Medizinonline

  https://medizinonline.com/en/diagnosis-and-therapy-in-wolff-parkinson-white-wpw-syndrome/

  ECG documentation during a tachycardia episode by 12-lead ECG or long-term ECG should also be sought. […] In addition, echocardiography should be performed once in all patients with WPW syndrome to exclude structural cardiopathies, especially congenital anomalies. […] Studies of noninvasive risk stratification have been performed in the past but have become much less important with the introduction of ablation therapy. […] An exercise ECG can be performed. […] Sudden loss of preexcitation at even mildly elevated heart rates during exercise generally implies a long refractory period of the accessory pathway and thus a low risk of sudden cardiac death. […] Also a low-risk indicator appears to be preexcitation that is only intermittent. […] Finally, ECG during AF can be used for risk stratification: very fast frequencies in AF with minimal RR intervals below 250 ms imply a very short pathway refractory period and accordingly have a higher risk of sudden cardiac death.

• #29 Diagnosis and therapy in Wolff-Parkinson-White (WPW) syndrome – Medizinonline

  https://medizinonline.com/en/diagnosis-and-therapy-in-wolff-parkinson-white-wpw-syndrome/

  ECG documentation during a tachycardia episode by 12-lead ECG or long-term ECG should also be sought. […] In addition, echocardiography should be performed once in all patients with WPW syndrome to exclude structural cardiopathies, especially congenital anomalies. […] Studies of noninvasive risk stratification have been performed in the past but have become much less important with the introduction of ablation therapy. […] An exercise ECG can be performed. […] Sudden loss of preexcitation at even mildly elevated heart rates during exercise generally implies a long refractory period of the accessory pathway and thus a low risk of sudden cardiac death. […] Also a low-risk indicator appears to be preexcitation that is only intermittent. […] Finally, ECG during AF can be used for risk stratification: very fast frequencies in AF with minimal RR intervals below 250 ms imply a very short pathway refractory period and accordingly have a higher risk of sudden cardiac death.

• #30 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  The main electrocardiographic features of pre-excitation are short PR interval (0.12 s), prolonged QRS complex (0.12 s), and slurred, slow-rising onset of the QRS complex, known as delta wave. […] Several algorithms (Chern-En Chiangs, Fitzpatricks, Xies, St Georges, and Pamdruns algorithms) have been used for predicting the accessory pathway location using different electrocardiographic criteria based on the analysis of the delta wave. […] The clinical presentation of WPW syndrome is generally unspecific, extremely variable, and, most importantly, it usually accompanies arrhythmic episodes. […] It is important to acknowledge that AVRT can appear during fetal life (most often between 24 and 32 weeks), representing about 70% of arrhythmias during intrauterine life and being one of the most important causes of heart failure with fetal hydrops.

• #31 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://www.mdpi.com/2075-4418/14/3/296

  The main electrocardiographic features of pre-excitation are short PR interval (<0.12 s), prolonged QRS complex (>0.12 s), and slurred, slow-rising onset of the QRS complex, known as delta wave. […] Several algorithms (Chern-En Chiang’s, Fitzpatrick’s, Xie’s, St George’s, and Pamdrun’s algorithms) have been used for predicting the accessory pathway location using different electrocardiographic criteria based on the analysis of the delta wave. […] The clinical presentation of WPW syndrome is generally unspecific, extremely variable, and, most importantly, it usually accompanies arrhythmic episodes. […] Currently, the idea of asymptomatic overt pre-excitation is challenged, as even in children, its presence is associated with reduced exercise capacity (due to APs-induced asynchrony and LV dysfunction).

• #32 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://www.mdpi.com/2075-4418/14/3/296

  The main electrocardiographic features of pre-excitation are short PR interval (<0.12 s), prolonged QRS complex (>0.12 s), and slurred, slow-rising onset of the QRS complex, known as delta wave. […] Several algorithms (Chern-En Chiang’s, Fitzpatrick’s, Xie’s, St George’s, and Pamdrun’s algorithms) have been used for predicting the accessory pathway location using different electrocardiographic criteria based on the analysis of the delta wave. […] The clinical presentation of WPW syndrome is generally unspecific, extremely variable, and, most importantly, it usually accompanies arrhythmic episodes. […] Currently, the idea of asymptomatic overt pre-excitation is challenged, as even in children, its presence is associated with reduced exercise capacity (due to APs-induced asynchrony and LV dysfunction).

• #33 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  The main electrocardiographic features of pre-excitation are short PR interval (0.12 s), prolonged QRS complex (0.12 s), and slurred, slow-rising onset of the QRS complex, known as delta wave. […] Several algorithms (Chern-En Chiangs, Fitzpatricks, Xies, St Georges, and Pamdruns algorithms) have been used for predicting the accessory pathway location using different electrocardiographic criteria based on the analysis of the delta wave. […] The clinical presentation of WPW syndrome is generally unspecific, extremely variable, and, most importantly, it usually accompanies arrhythmic episodes. […] It is important to acknowledge that AVRT can appear during fetal life (most often between 24 and 32 weeks), representing about 70% of arrhythmias during intrauterine life and being one of the most important causes of heart failure with fetal hydrops.

• #34 Wolff Parkinson White Syndrome: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/wolff-parkinson-white-syndrome-diagnosis-and-treatment/

  The term Wolff-Parkinson-White (WPW) syndrome is used to refer to the combination of supraventricular arrhythmias and an electrocardiographic pattern of preexcitation. […] The purpose of this brief review is to review the pathophysiologic basis of the WPW syndrome, and the approach to diagnosis and management. […] WPW syndrome occurs when there is an antegradely conducting accessory pathway (AP), as well as one or more types of supraventricular arrhythmias. […] A pattern of preexcitation on a 12-lead ECG reflects the presence of an antegradely conducting accessory pathway and consists of the constellation of a short PR interval, a widened QRS complex, and a delta wave which is a slow upstroke of the QRS complex. […] Rapid intravenous administration of adenosine causing blockage or slowing of AV nodal conduction and exposing the anterograde AP conduction has been used as a diagnostic maneuver.

• #35 Wolff Parkinson White Syndrome: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/wolff-parkinson-white-syndrome-diagnosis-and-treatment/

  The presence of intermittent preexcitation has been considered to suggest that the antegrade refractory period of the AP is long, making them very unlikely to mediate a rapid, preexcited ventricular response during atrial fibrillation which is known to be a risk factor for sudden cardiac death. […] Electrophysiology study (EPS) in patients with WPW syndrome can help to confirm the presence of an AP, differentiate this condition from other forms of SVT, and to localize the pathway participating in the tachycardia for ablative therapy. […] Management of patients with AP can vary depending on the symptoms, prognosis, and patients preference. […] The ACC/AHA/ESC Guidelines for Management of Patients with Supraventricular Arrhythmias gives catheter ablation a 2A classification for treatment of patients with asymptomatic preexcitation.

• #36 Wolff-Parkinson-White Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  The differential diagnosis for WPW pattern and syndrome is broad and can be broken down by the symptoms, ECG pattern, or with the type of dysrhythmia that the patient presents. […] The prognosis for patients with WPW pattern has improved significantly as antiarrhythmic medications, and ablation techniques were developed over the last 80 years. For patients who have WPW syndrome, high-risk factors, or strong preference, radiofrequency catheter ablation can be curative and has high success rates with low rates of complications.

• #37 Pre-excitation syndromes • LITFL • ECG Library Diagnosis

  https://litfl.com/pre-excitation-syndromes-ecg-library/

  WPW Syndrome refers to the presence of a congenital accessory pathway (AP) and episodes of tachyarrhythmias. The term is often used interchangeablely with pre-excitation syndrome […] The direction of conduction affects the appearance of the ECG in sinus rhythm and during tachyarrhythmias. […] In patients with retrograde-only accessory conduction, all anterograde conduction occurs via the AV node. No pre-excitation occurs and therefore no features of WPW are seen on the ECG in sinus rhythm. This is termed a concealed pathway. […] There are only two main forms of tachyarrhythmias that occur in patients with WPW these are discussed separately: Atrial fibrillation or flutter. Due to direct conduction from atria to ventricles via an AP, bypassing the AV node […] Atrioventricular re-entry tachycardia (AVRT). Due to formation of a re-entry circuit involving the AP.

• #38 Pre-excitation syndromes • LITFL • ECG Library Diagnosis

  https://litfl.com/pre-excitation-syndromes-ecg-library/

  WPW Syndrome refers to the presence of a congenital accessory pathway (AP) and episodes of tachyarrhythmias. The term is often used interchangeablely with pre-excitation syndrome […] The direction of conduction affects the appearance of the ECG in sinus rhythm and during tachyarrhythmias. […] In patients with retrograde-only accessory conduction, all anterograde conduction occurs via the AV node. No pre-excitation occurs and therefore no features of WPW are seen on the ECG in sinus rhythm. This is termed a concealed pathway. […] There are only two main forms of tachyarrhythmias that occur in patients with WPW these are discussed separately: Atrial fibrillation or flutter. Due to direct conduction from atria to ventricles via an AP, bypassing the AV node […] Atrioventricular re-entry tachycardia (AVRT). Due to formation of a re-entry circuit involving the AP.

• #39 Diagnosis and therapy in Wolff-Parkinson-White (WPW) syndrome – Medizinonline

  https://medizinonline.com/en/diagnosis-and-therapy-in-wolff-parkinson-white-wpw-syndrome/

  In patients with WPW syndrome, orthodromic AV reentry tachycardia (regular narrow complex tachycardia) is most common, but antidromic AV reentry tachycardia (regular wide complex tachycardia) or atrial fibrillation with conduction across the pathway (irregular wide complex tachycardia) may rarely occur. […] The acute therapy of choice in patients with WPW syndrome and persistent symptomatic orthodromic AV reentry tachycardia (regular narrow complex tachycardia) is the performance of vagal maneuvers and, if they fail, parenteral administration of adenosine. […] The acute therapy of choice in patients with WPW syndrome and atrial fibrillation (irregular wide-complex tachycardia) in a hemodynamically unstable situation is electrocardioversion. […] Basic diagnostics should include history, physical examination, and a 12-lead sinus rhythm ECG to document preexcitation.

• #40 Wolff-Parkinson-White Syndrome – Part 2 – ECG Medical Training

  https://www.ecgmedicaltraining.com/wolff-parkinson-white-syndrome-part-2/

  Now we’d like to look at the tachyarrhythmias associated with Wolff-Parkinson-White syndrome. […] Let’s move on to the tachyarrhythmias associated with Wolff-Parkinson-White syndrome. […] Atrial fibrillation in the setting of Wolff-Parkinson-White syndrome can be quite dangerous! […] The ECG in AF/WPW is quite unique. […] Although the 2010 AHA ECC Guidelines suggest that amiodarone is a viable option for these patients, many including Amal Mattu, M.D. and my old friend Andrew Bowman have long argued that amiodarone should not be given. […] Procainamide or ibutilide may be the only appropriate medications for these patients. […] It’s worth remembering that the same potential thromboembolic complications apply to these patients as for any other patient presenting with atrial fibrillation or atrial flutter.

• #41 Wolff-Parkinson White Syndrome (WPW): Atrio-ventricular Reentry Tachycardia – AF-ABLATION

  https://af-ablation.org/en/arrhythmological-disorders/supraventricular-tachycardia/wolff-parkinson-white-syndrome-wpw-atrio-ventricular-reentry-tachycardia/

  An extremely low percentage of patients with WPW suddenly die from ventricular fibrillation. The mechanism is almost certainly an atrial fibrillation with a high ventricular response, which degenerates into a ventricular fibrillation due to the high ventricular rate. This is a dramatic event that can also occur in asymptomatic subjects, with an incidence of 1:1000 subjects per year. It was observed that all patients with pre-excitation who were revived from cardiac arrest had a short antegrade refractory period ( 250 ms) of the accessory pathway. On the basis of these data, it has been proposed to consider patients at risk with this electrophysiological result. However, the positive predictive value of this parameter is very low, since about 20% of subjects subjected to an EP study have these characteristics and should therefore be considered at risk, while the actual incidence of sudden death is considerably lower.

• #42 Wolff-Parkinson-White syndrome: Diagnostic and management strategies | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/92/2/119

  A distinction: WPW pattern is diagnosed in patients who have no symptoms but who do have the aforementioned electrocardiographic signs, while a diagnosis of WPW syndrome means the patient has a WPW pattern and symptoms related to arrhythmias caused by the accessory pathway. […] The management challenge lies in those with WPW pattern but no symptoms. […] Catheter ablation has a class I (strong) recommendation in patients who have symptoms and the WPW pattern (WPW syndrome). […] More electrophysiologists now than in the past may be performing electrophysiologic studies in patients with an asymptomatic WPW pattern regardless of noninvasive findings. […] This highlights the importance of careful monitoring and management of patients with WPW pattern and syndrome, given the potential for serious complications even without prior symptoms and high-risk features.

• #43 Wolff-Parkinson-White syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/400

  Wolff-Parkinson-White (WPW) syndrome occurs when myocardial fibres connect the atrium to the ipsilateral ventricle across the mitral or tricuspid annulus (accessory pathway), pre-exciting the ventricle. […] Asymptomatic patients can either be monitored or screened to determine whether they have a 'high-risk’ accessory pathway, in which case catheter ablation is typically performed. […] Screening to determine whether a patient has a high-risk accessory pathway is recommended for patients who have high-risk occupations, such as school bus drivers or pilots, and also for competitive athletes. […] In patients with asymptomatic pre-excitation who have an accessory pathway demonstrating low risk features on invasive or non-invasive screening, an electrophysiology study and ablation can be considered.

• #44 Wolff Parkinson White Syndrome: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/wolff-parkinson-white-syndrome-diagnosis-and-treatment/

  Based on the results of these studies, as well as the well-established safety and efficacy of catheter ablation of APs, most electrophysiologists will discuss the option of performing an EPS as a risk stratification tool to all asymptomatic patients with a pattern of preexcitation on an ECG. […] Catheter ablation of APs is performed in conjunction with a diagnostic EPS. After the AP has been localized to a region of the heart, precise mapping and ablation are performed using a steerable electrode catheter.

• #45 Wolff Parkinson White Syndrome: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/wolff-parkinson-white-syndrome-diagnosis-and-treatment/

  The presence of intermittent preexcitation has been considered to suggest that the antegrade refractory period of the AP is long, making them very unlikely to mediate a rapid, preexcited ventricular response during atrial fibrillation which is known to be a risk factor for sudden cardiac death. […] Electrophysiology study (EPS) in patients with WPW syndrome can help to confirm the presence of an AP, differentiate this condition from other forms of SVT, and to localize the pathway participating in the tachycardia for ablative therapy. […] Management of patients with AP can vary depending on the symptoms, prognosis, and patients preference. […] The ACC/AHA/ESC Guidelines for Management of Patients with Supraventricular Arrhythmias gives catheter ablation a 2A classification for treatment of patients with asymptomatic preexcitation.

• #46 Wolff-Parkinson White Syndrome (WPW): Atrio-ventricular Reentry Tachycardia – AF-ABLATION

  https://af-ablation.org/en/arrhythmological-disorders/supraventricular-tachycardia/wolff-parkinson-white-syndrome-wpw-atrio-ventricular-reentry-tachycardia/

  An extremely low percentage of patients with WPW suddenly die from ventricular fibrillation. The mechanism is almost certainly an atrial fibrillation with a high ventricular response, which degenerates into a ventricular fibrillation due to the high ventricular rate. This is a dramatic event that can also occur in asymptomatic subjects, with an incidence of 1:1000 subjects per year. It was observed that all patients with pre-excitation who were revived from cardiac arrest had a short antegrade refractory period ( 250 ms) of the accessory pathway. On the basis of these data, it has been proposed to consider patients at risk with this electrophysiological result. However, the positive predictive value of this parameter is very low, since about 20% of subjects subjected to an EP study have these characteristics and should therefore be considered at risk, while the actual incidence of sudden death is considerably lower.

• #47 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  The main electrocardiographic features of pre-excitation are short PR interval (0.12 s), prolonged QRS complex (0.12 s), and slurred, slow-rising onset of the QRS complex, known as delta wave. […] Several algorithms (Chern-En Chiangs, Fitzpatricks, Xies, St Georges, and Pamdruns algorithms) have been used for predicting the accessory pathway location using different electrocardiographic criteria based on the analysis of the delta wave. […] The clinical presentation of WPW syndrome is generally unspecific, extremely variable, and, most importantly, it usually accompanies arrhythmic episodes. […] It is important to acknowledge that AVRT can appear during fetal life (most often between 24 and 32 weeks), representing about 70% of arrhythmias during intrauterine life and being one of the most important causes of heart failure with fetal hydrops.

• #48 Get Wolff-Parkinson-White Syndrome Treatment | Cleveland Clinic Children’s

  https://my.clevelandclinic.org/pediatrics/services/wolff-parkinson-white-syndrome-treatment

  Wolff-Parkinson-White (WPW) syndrome is a rare congenital (born with it) condition that causes the electrical signals in your childs heart to travel a different way. This change can cause an arrhythmia, making their heart beat too fast. […] Cleveland Clinic Childrens cardiology experts specialize in diagnosing WPW and other congenital heart conditions in children and young adults. […] Symptoms play a big part in confirming a diagnosis. Your childs healthcare provider will ask you what symptoms theyre having, how long theyve had them and how theyre feeling. Theyll also do a physical exam and listen to your childs heartbeat. […] And to better understand your childs heart rate changes, they may order tests like: An electrocardiogram (EKG), An echocardiogram (Echo), A Holter monitor, An exercise stress test.

• #49 Wolff-Parkinson-White Syndrome in a Young Athlete | Consultant360

  https://www.consultant360.com/case-point/wolff-parkinson-white-syndrome-young-athlete

  An EPS can better characterize an accessory pathway, and radiofrequency catheter ablation can be performed during the study, as was the case with our patient. […] Treatment of WPW includes both pharmacological and procedural options (Table 2). Currently, catheter ablation, which involves inserting a catheter into the right femoral vein and using radiofrequency energy to ablate accessory pathways, is the treatment of choice; it has an overall long-term success rate of 95%. […] The treatment of WPW pattern is controversial in children because many remain asymptomatic for their entire life. […] For athletes and children with WPW syndrome, early treatment is recommended. […] In patients with multiple accessory pathways or a ventricular rate exceeding 240 beats/min, catheter ablation is always recommended. […] Further research on screening pediatric patients and athletes is needed because of the increased risk of sudden cardiac death.

• #50 Wolff-Parkinson-White Syndrome in a Young Athlete | Consultant360

  https://www.consultant360.com/case-point/wolff-parkinson-white-syndrome-young-athlete

  An EPS can better characterize an accessory pathway, and radiofrequency catheter ablation can be performed during the study, as was the case with our patient. […] Treatment of WPW includes both pharmacological and procedural options (Table 2). Currently, catheter ablation, which involves inserting a catheter into the right femoral vein and using radiofrequency energy to ablate accessory pathways, is the treatment of choice; it has an overall long-term success rate of 95%. […] The treatment of WPW pattern is controversial in children because many remain asymptomatic for their entire life. […] For athletes and children with WPW syndrome, early treatment is recommended. […] In patients with multiple accessory pathways or a ventricular rate exceeding 240 beats/min, catheter ablation is always recommended. […] Further research on screening pediatric patients and athletes is needed because of the increased risk of sudden cardiac death.

• #51 Wolff-Parkinson-White Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554437/

  Recommendations for further evaluation, risk stratification, electrophysiologic study, and accessory pathway ablation for asymptomatic patients with WPW pattern vary depending on age, risk factors, history of symptoms, comorbidities, baseline ECG pattern, as well as a personal and expert opinion. In general, young, healthy patients without comorbid conditions or significant risk factors who have the WPW pattern on ECG but are asymptomatic and without a history of suspected tachyarrhythmia are likely safe for watchful waiting with primary care and or cardiology follow up. […] Patients that present with a symptomatic tachyarrhythmia or an episode concerning recent arrhythmia will require an ECG to assess current cardiac rate, rhythm, and morphology but will also require further evaluation. The patient who presents with an acute tachyarrhythmia can be evaluated and managed following the „2010 American Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.”

• #52 Wolff Parkinson White Syndrome – The Cardiology Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/cardiology/wolff-parkinson-white-syndrome-diagnosis-and-treatment/

  Wolff Parkinson White syndrome, or WPW syndrome, is a condition that occurs when an extra electrical pathway in the heart causes a rapid heartbeat leading to congenital pre-excitation of the heart. […] The hallmark finding of Wolff Parkinson White syndrome is the electrocardiographic (ECG) finding of the delta wave. […] Because some Wolff Parkinson White syndrome patients never develop an arrhythmia, these patients may be asymptomatic and have a normal physical exam. […] Patients who previously experienced arrhythmia may have learned of their condition if an ECG was performed and exhibited the hallmark delta wave ECG finding associated with Wolff Parkinson White syndrome. […] The initial diagnostic workup for Wolff Parkinson White syndrome includes the surface ECG. […] ECG findings that are associated with Wolff Parkinson White syndrome include a short PR interval (120 ms), prolonged QRS complex (120 ms), and QRS morphology that includes a slurred delta wave.

• #53 Wolff-Parkinson-White syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/400

  Wolff-Parkinson-White (WPW) syndrome occurs when myocardial fibres connect the atrium to the ipsilateral ventricle across the mitral or tricuspid annulus (accessory pathway), pre-exciting the ventricle. […] Asymptomatic patients can either be monitored or screened to determine whether they have a 'high-risk’ accessory pathway, in which case catheter ablation is typically performed. […] Screening to determine whether a patient has a high-risk accessory pathway is recommended for patients who have high-risk occupations, such as school bus drivers or pilots, and also for competitive athletes. […] In patients with asymptomatic pre-excitation who have an accessory pathway demonstrating low risk features on invasive or non-invasive screening, an electrophysiology study and ablation can be considered.

• #54 Management of Wolff-Parkinson-White Syndrome in the Elderly | ECR Journal

  https://www.ecrjournal.com/articles/management-wolff-parkinson-white-syndrome-elderly?language_content_entity=en

  Electrophysiological study is the most reliable method of establishing the prognosis of WPW syndrome. […] WPW syndrome is considered to represent a risk of sudden death when the following association is observed: sustained atrial fibrillation is induced and the shortest respiratory rate (RR) interval between pre-excited beats is less than 250ms in the control state in adults or less than 200ms during isoproterenol infusion. […] The prevalence of a potentially malignant form of WPW syndrome in asymptomatic subjects does not decrease significantly with age. […] Taking into account the possible risks linked to this condition, it is important to carry out investigations such as exercise testing and electrophysiological study for WPW syndrome, irrespective of the age of a subject, even if they are asymptomatic, particularly if the patient continues to exercise or needs to undergo extensive surgery. […] Ablation of the accessory pathway is indicated as soon as the patient becomes symptomatic, but this should be performed carefully due to the difficulty of accessing a left bundle of Kent.

• #55 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10855590/

  WolfParkinsonWhite (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. […] Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias. […] The diagnosis of WPW syndrome is reserved strictly for patients who have both pre-excitation and symptoms. Identification of WPW patterns in the general population is extremely difficult, as these patients are, by definition, without palpitations, syncope, or other symptoms secondary to ventricular pre-excitation.

• #56 Wolff-Parkinson-White (WPW) Syndrome | Doctor

  https://patient.info/doctor/wolff-parkinson-white-syndrome-pro

  RF ablation is increasingly being used both in common types of arrhythmia and selected asymptomatic patients, with a 95% success rate. […] Indications for RF ablation include: Patients with symptomatic AV re-entrant tachycardia. […] Although largely superseded by RF ablation, surgical ablation may still be indicated for patients in whom RF ablation has failed, those who need heart surgery for other reasons and for those patients with multifocal abnormalities requiring surgical ablation (rare). […] WPW syndrome can present with several forms of tachydysrhythmia, depending on the pathway of the aberrant rhythm, including reciprocating tachycardias and atrial fibrillation. […] The prognosis depends on the intrinsic electrophysiological properties of the accessory pathway rather than on symptoms.

• #57 Wolff-Parkinson-White syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/400

  Symptomatic patients usually undergo catheter ablation as first-line therapy. […] Catheter ablation is highly effective with low risk and can be used either as initial therapy or for patients experiencing side effects or arrhythmia recurrences despite medical treatment. […] 1st investigations to order: 12-lead ECG. […] Investigations to consider: echocardiogram, treadmill exercise test, electrophysiology study.

• #58 Wolff Parkinson White Syndrome: Diagnosis and Treatment – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/cardiology/wolff-parkinson-white-syndrome-diagnosis-and-treatment/

  Based on the results of these studies, as well as the well-established safety and efficacy of catheter ablation of APs, most electrophysiologists will discuss the option of performing an EPS as a risk stratification tool to all asymptomatic patients with a pattern of preexcitation on an ECG. […] Catheter ablation of APs is performed in conjunction with a diagnostic EPS. After the AP has been localized to a region of the heart, precise mapping and ablation are performed using a steerable electrode catheter.

• #59 Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

  https://www.mdpi.com/2075-4418/14/3/296

  Management of asymptomatic patients with WPW patterns has always been controversial because asymptomatic does not preclude sudden cardiac death. […] Depending on the noninvasive and/or invasive evaluation, there are several indications in which catheter ablation is indicated, even in asymptomatic patients. […] RFA has completely revolutionized the approach to the management of WPW syndrome, becoming the method of choice potentially available to all WPW patients. Long-term results from registry studies demonstrated that there is a striking difference in outcomes between ablated and nonablated patients.

• #60 Wolff-Parkinson-White Syndrome Presenting After a Motorcycle Accident | Kaya | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/331/230

  Early diagnosis, correct treatment, and patient education are of principal importance in patients with WPW syndrome. Patients should be referred for catheter ablation, and conduction abnormalities (e.g., AV block or slowing of conduction) can be handled clinically with the placement of a permanent pacemaker. Periodic follow-up care of patients is necessary, along with consideration for EPS and prophylactic catheter ablation. This is especially true in asymptomatic young patients who have been told of their abnormal ECG results.

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