PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern
Abstract
The purpose of this consensus statement is to provide up-to-date clinical practice guidelines on the evaluation and management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW) electrocardiographic (ECG) pattern. 1 The terminology WPW was first used to describe a "bundle-branch pattern" with a short PR interval in healthy young people prone to paroxysmal tachycardia and/or atrial fibrillation. Although isolated case reports preceded the 1930 landmark manuscript, history correctly credits identification of the syndrome to Drs.
Wolff, Parkinson, and White. Over the years, the syndrome evolved through observations by anatomists and electrophysiologists to appreciate a reentrant circuit involving both the AV node-His axis as well as the accessory pathway.
Isolated ventricular preexcitation refers to the abnormal ECG pattern in the absence of any clinical cardiovascular symptoms. Isolated ventricular preexcitation has historically been termed "asymptomatic WPW" or asymptomatic WPW syndrome.
This manuscript provides guidelines only for individuals with an abnormal ECG pattern of ventricular preexcitation without symptoms. In response to recently published literature regarding patients with WPW, the Pediatric and Congenital Electrophysiology Society (PACES) in conjunction with the Heart Rhythm Society (HRS) created a writing committee to provide helpful clinical guidelines for asymptomatic patients with WPW.
There are at present no specific guidelines addressing risk stratification in the asymptomatic young patient with WPW. Selected members from within PACES and HRS have reviewed and analyzed the published scientific literature, carefully assessing the absolute and relative risks of invasive procedures and therapies so as to provide a practical approach to optimize patient care.