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Wolff-Parkinson-White Syndrome: A Master of Disguise

Wolff-Parkinson-White syndrome is the most common form of ventricular preexcitation and affects 1-3 per 1,000 persons worldwide. Many patients remain asymptomatic throughout their lives; however, approximately half of the patients with Wolff-Parkinson-White syndrome experience symptoms secondary to tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, and, rarely, ventricular fibrillation and sudden death. Patients with Wolff-Parkinson-White syndrome may present with a multitude of symptoms such as unexplained anxiety, palpitations, fatigue, light-headedness or dizziness, loss of consciousness, and shortness of breath.

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 The Asymptomatic Wolff-Parkinson-White Patient: Time to Be More Proactive?

It is well known by now that sudden cardiac death (SCD) may occur even in the asymptomatic individual with Wolff-Parkinson-White (WPW) pattern.1 This is related to the occurrence of atrial fibrillation with a rapid ventricular response leading to ventricular fibrillation (VF). The essential and critical risk factor is the presence of an accessory pathway(s) (AP) with critically short antegrade refractoriness.

Articles of Interest

The History of the Wolff–Parkinson–White Syndrome

While Drs Wolff, Parkinson, and White fully described the syndrome in 1930, prior case reports had described the essentials. Over the ensuing century this syndrome has captivated the interest of anatomists, clinical cardiologists, and cardiac surgeons. Stanley Kent described lateral muscular connections over the atrioventricular (AV) groove which he felt were the normal AV connections.

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. This syndrome was first described in 1930 in an article by Louis Wolff, Sir John Parkinson, and Paul Dudley White.

Wolff-Parkinson-White Syndrome: A Genetic Disease?

The history of the Wolff-Parkinson-White (WPW) syndrome is a 50-year–long tale of speculation and discussion among physiologists, anatomists, and clinicians about how to explain the frequently occurring tachycardias in patients showing a strange ECG. That riddle was solved in 1967 in Amsterdam when Durrer and associates showed that the WPW syndrome was based on a second connection between the atrium and ventricle apart from the normal AV node–His pathway. The presence of conduction over such an accessory AV pathway was demonstrated by epicardial mapping during sinus rhythm.

WPW syndrome: the ‘Rosetta stone’ of rhythmology. The history of the Rosetta stone

Prior to the ‘discovery’ of the Wolff–Parkinson–White syndrome, interpreting the respective phenomena was akin to reading hieroglyphic characters; thus a clear pathophysiological understanding and practical clinical diagnosis were impossible. The epochal work by Wolff, Parkinson, and White, which resulted in the electrophysiologically correct interpretation of circus movements as the cause of tachycardic rhythm disorders, can therefore indeed be compared to the deciphering of hieroglyphic writing by Champollion in 1822 with the aid of the Rosetta stone.

Resources

Wolff Parkinson White Type A

The PR interval is short (0.12 seconds). There is a delta wave present in all leads but this is particularly well seen in leads I, II, and V1-V6. Total QRS duration is prolonged (0.14 seconds). There is a tall R wave in the right sided precordial leads and non-specific ST segment/T wave changes accompany this.

Geeky Medics

In Wolff-Parkinson-White, an accessory pathway leads to stimulation of the ventricles. The accessory pathway enables electrical conduction to bypass the AV node and stimulate the proximal ventricles prematurely (pre-excitation). This, in addition to normal electrical conduction through the AV node, leads to ‘double excitation’ of the ventricles.

Pre-excitation syndromes

Wolff-Parkinson-White (WPW) Syndrome is a combination of the presence of a congenital accessory pathway and episodes of tachyarrhythmia.

SADS Foundation

Treatment can include daily medications or cardiac ablation techniques. Patients with symptomatic SVTs or patients identified with high-risk AP profiles during electrophysiological testing could be considered for ablation procedures.

Arrhythmia Alliance

WPW syndrome usually isn't serious. Many people will have no symptoms or only experience occasional, mild episodes of their heart racing. With treatment, the condition can normally be completely cured. For some people, their condition settles down without needing treatment. WPW syndrome can sometimes be life-threatening, particularly if it occurs alongside a type of irregular heartbeat called atrial fibrillation, but this is rare and treatment can eliminate this risk.

NHS

In many cases, episodes of abnormal heart activity associated with WPW syndrome are harmless, don't last long, and settle down on their own without treatment.

NORD

The symptoms associated with WPW syndrome vary greatly from case to case. Some individuals may not have any abnormal heartbeats or associated symptoms (asymptomatic). Although the disorder is present at birth (congenital), symptoms may not become apparent until adolescent or early adulthood.

Patient Stories

Wolff-Parkinson-White Syndrome (WPW) patient stories.