Wolff–Parkinson–White syndrome
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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 developed 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 irregular heartbeat that occurs is known as paroxysmal supraventricular tachycardia.[1]
Wolff–Parkinson–White syndrome | |
---|---|
Other names | WPW 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. | |
Specialty | Cardiology |
Symptoms | Abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, loss of consciousness[1][2] |
Complications | Cardiomyopathy, stroke, sudden cardiac death[2] |
Usual onset | Birth[1] |
Causes | Accessory pathway in the heart[1] |
Diagnostic method | Electrocardiogram shows a short PR interval and a wide QRS complex from a delta wave[3] |
Treatment | Watchful waiting, medications, radiofrequency catheter ablation[4][5] |
Prognosis | Without symptoms 0.5% (children), 0.1% (adults) risk of death per year[5] |
Frequency | 0.2%[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]