title: Wolff-Parkinson-White syndrome: lessons learnt and lessons remaining.
abstract: The Wolff-Parkinson-White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope - the "delta wave". It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation <250 ms. Owing to the relatively high prevalence of asymptomatic Wolff-Parkinson-White pattern and availability of catheter ablation, there has been a need to identify risk among asymptomatic patients. Recent guidelines recommend invasive evaluation for such patients where pre-excitation clearly does not disappear during exercise testing. This strategy has a high negative predictive value only. The accuracy of this approach is under continued investigation, especially in light of other considerations: Patients having intermittent pre-excitation, once thought to be at minimal risk may not be, and the role of isoproterenol in risk assessment.
authors.affiliation: 1Congenital & Pediatric Cardiac Research,Department of Pediatrics,Children's Hospital of Wisconsin,Milwaukee,Wisconsin,United States of America.
authors.forename: D Woodrow
authors.initials: DW
authors.lastname: Benson
authors.affiliation: 2Heart Center, Department ofPediatric Cardiology,Phoenix Children's Hospital,University of Arizona College of Medicine-Phoenix,Phoenix, Arizona,United States of America.
authors.forename: Mitchell I
authors.initials: MI
authors.lastname: Cohen
mesh_terms: D058606:Accessory Atrioventricular Bundle; D001281:Atrial Fibrillation / Q000209:etiology*; D017115:Catheter Ablation / Q000009:adverse effects*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005080:Exercise Test; D049673:History, 20th Century; D006801:Humans; D007545:Isoproterenol / Q000494:pharmacology; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D054139:Tachycardia, Reciprocating / Q000503:physiopathology; D014927:Wolff-Parkinson-White Syndrome / Q000453:epidemiology* / Q000266:history*
chemical_list: D007545:Isoproterenol
keywords: Wolff–Parkinson–White; atrial fibrillation; sudden death