Asymptomatic Wolff-Parkinson-White Syndrome: An Ounce of Prevention Is Worth the Risk of Cure

Etheridge, Susan P.; Gakenheimer‐Smith, Lindsey; Asaki, S. Yukiko

doi:10.1007/s11886-023-01879-6

Cited by 6 publications

(4 citation statements)

References 55 publications

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“…However, the management of asymptomatic individuals remains a topic of active debate and scholarly scrutiny. 12 Incomplete ablation of the accessory pathway (AP) can often stem from the existence of multiple pathways that elude detection during the electrophysiological study. When spaced by an interval of 1-3 cm, the presence of several accessory paths (APs) has been documented.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Orthodromic SVT AVRT with Multiple Accessory Pathway in WPW Syndrome: Ablate All or Not?

Aziz,

Rizal

2024

HSJ

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Background: Patients diagnosed with Wolff-Parkinson-White syndrome (WPW) have a relatively low, nevertheless persistent risk of unexpected mortality. However, this risk can be effectively mitigated by applying radiofrequency catheter ablation targeting the accessory pathway. It is difficult to accurately study predictors because only a minority of patients develop potentially malignant arrhythmias (MA) or passed away, despite essential risk variables being relatively well-known.1 This study aimed to describe ablation in WPW syndrome. Case presentation: A 16-year-old male presents with symptoms characterized by palpitations during intense physical exertion, followed by chest pain episodes. The physical examination, CXR, laboratorium, and echocardiography were all within the normal range; his ECG showed shortened PR interval and a delta wave with a positive delta wave at V1 and mostly positive at the inferior lead. He also has recorded ECG when the patient has a tachycardia event with SVT AVRT orthodromic pattern. He underwent EP Study and had several accessory pathways at the posteroseptal mitral annulus and anteroseptal tricuspid. The decision was made to perform ablation on the posteroseptal accessory pathway located at the mitral annulus. An electrophysiology (EP) investigation was conducted at the anteroseptal tricuspid annulus, which did not induce tachyarrhythmia. Conclusion: Wolff-Parkinson-White syndrome is a congenital cardiac pathway formation, with not all accessory pathways causing tachyarrhythmias. Ablation therapy is necessary for patients with multiple pathways, with pathways with an ERP less than 250 being the only option. Keyword: Ablation, Multiple Accessories Pathway, SVT AVRT Orthodromic, WPW Syndrome.

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Section: Discussionmentioning

confidence: 99%

Recurrent Orthodromic SVT AVRT with Multiple Accessory Pathway in WPW Syndrome: Ablate All or Not?

Aziz,

Rizal

2024

HSJ

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“…However, more recent data about children with a life-threatening event as the sentinel symptom raise concern, and correct identification and treatment of this population can be lifesaving [20,37,48]. However, SPERRI and SPPCL during EPT have a weak or no correlation with SPERRI measured during a clinical episode of atrial fibrillation with anterograde conduction (Clinical-SPERRI), at least in children (most probably due to the effect of deep-sedation/general anesthesia +/− mechanical inhibition by the diagnostic catheters) [89]. Accurate risk stratification is extremely important, given the number of children with asymptomatic WPW who may be at risk of sudden death and the availability of catheter ablation, which is a highly successful curative procedure [47].…”

Section: Invasive Assessmentmentioning

confidence: 99%

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

Vătășescu,

Paja,

Șuș

et al. 2024

Diagnostics

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Wolf–Parkinson–White (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. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1–0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. 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.

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“…Given the high likelihood of success and low risk of complications with catheter ablations, many paediatric electrophysiologists adopt an aggressive approach to asymptomatic WPW that includes invasive EP studies with pre-emptive ablation. 13 Consider also the use of pre-operative EP assessment and pre-emptive catheter ablation of latent substrates in Ebstein malformation of the tricuspid valve before tricuspid valve replacement. 14 This approach is deemed advisable due to concerns that tricuspid valve intervention may render arrhythmia substrates inaccessible and compromise the efficacy of catheter ablation.…”

mentioning

confidence: 99%

Before it is too late: pre-emptive ablation strategies in tetralogy of Fallot

Niu,

Pilcher,

Etheridge

2024

Europace

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Asymptomatic Wolff-Parkinson-White Syndrome: An Ounce of Prevention Is Worth the Risk of Cure

Cited by 6 publications

References 55 publications

Recurrent Orthodromic SVT AVRT with Multiple Accessory Pathway in WPW Syndrome: Ablate All or Not?

Recurrent Orthodromic SVT AVRT with Multiple Accessory Pathway in WPW Syndrome: Ablate All or Not?

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

Before it is too late: pre-emptive ablation strategies in tetralogy of Fallot

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