Evaluation and Management of the Asymptomatic Child with Wolff–Parkinson–White

Abstract

Wolff-Parkinson-White (WPW) describes an accessory pathway (AP) that connects the atria and ventricles and allows preexcitation of the ventricle, manifested on the electrocardiogram (ECG) as a short PR interval and a delta wave. WPW syndrome describes the abnormal ECG pattern in patients with associated clinical cardiovascular symptoms, whereas ''isolated ventricular preexcitation,'' ''asymptomatic WPW,'' or ''asymptomatic WPW syndrome'' all refer to the abnormal ECG pattern without associated clinical cardiovascular symptoms. The clinical presentation of symptomatic WPW in young patients with structurally normal hearts can vary based on age and accessory pathway properties. Unfortunately, sudden cardiac death (SCD) can be the first manifestation in patients with WPW. Non-invasive modalities (ECG, ambulatory monitoring, and exercise testing) are used to risk stratify patients. A more invasive test (electrophysiology study) can then be used to identify high-risk pathways. Finally, radiofrequency and/or cryoablation are used to eliminate the accessory pathway and eliminate the risk of arrhythmia and SCD.