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Wolff-Parkinson-White syndrome

Last reviewed: 21 Oct 2024
Last updated: 24 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • atrioventricular re-entrant tachycardia (AVRT)
Full details

Other diagnostic factors

  • palpitations
  • dizziness
  • shortness of breath
  • chest pain
  • atrial fibrillation
  • atrial flutter
  • congenital cardiac abnormalities
  • sudden cardiac death
  • syncope and presyncope
  • tachycardia in pregnancy
Full details

Risk factors

  • Ebstein anomaly
  • hypertrophic cardiomyopathy
  • mitral valve prolapse
  • atrial septal defect
  • ventricular septal defect
  • transposition of great vessels
  • coarctation of aorta
  • dextrocardia
  • coronary sinus diverticula
  • right and left atrial aneurysms
  • cardiac rhabdomyomas
  • Marfan syndrome
  • Friedreich ataxia
  • family history
Full details

Diagnostic tests

1st tests to order

  • 12-lead ECG
Full details

Tests to consider

  • echocardiogram
  • treadmill exercise test
  • electrophysiology study
Full details

Treatment algorithm

INITIAL

unstable: BP <90/60 mmHg, signs of systemic hypoperfusion or unstable atrial fibrillation

ACUTE

stable: narrow complex (orthodromic atrioventricular reciprocating) tachycardia

stable: wide complex (antidromic atrioventricular reciprocating) tachycardia

stable: pre-excited tachycardia due to atrial fibrillation or atrial flutter

stable: pre-excited tachycardia due to atrial tachycardia

ONGOING

following acute treatment: asymptomatic

following acute treatment: symptomatic

Contributors

Authors

Hugh Calkins, MD

Professor of Medicine

Director of Electrophysiology

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

HC declares that he is a consultant for Medtronic, Biosense Webster, Abbott, and Boston Scientific.

Acknowledgements

We would like to acknowledge our cardiology expert panel member, Dr Fred Kusumoto, for his contribution to this topic.

Professor Hugh Calkins would like to gratefully acknowledge Dr David Frankel, Dr Mithilesh K. Das, and Dr Douglas P. Zipes, previous contributors to this topic.

Disclosures

DF, MKD, and DPZ declare that they have no competing interests.

Peer reviewers

Nicolas Palaskas, MD, FACC

Assistant Professor

University of Texas MD Anderson Cancer Center

Houston

TX

Disclosures

NP declares that he has no competing interests.

Joseph E. Marine, MD

Associate Professor of Medicine

Director of Electrophysiology

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

JEM declares that he has no competing interests.

Suneet Mittal, MD

Director

Electrophysiology Laboratory

The St. Luke's-Roosevelt Hospital Center

New York

NY

Disclosures

SM declares that he has no competing interests.

Andrew Turley, MB ChB

Cardiology Specialist Registrar

The James Cook University Hospital

Middlesbrough

UK

Disclosures

AT declares that he has no competing interests.

Steve Hsu, MD

Associate Professor

Department of Medicine

Division of Cardiology

University of Florida College of Medicine

Jacksonville

FL

Disclosures

SH declares that he has no competing interests.

  • Wolff-Parkinson-White syndrome images
  • Differentials

    • Atriofascicular pathway
    • Lown-Ganong-Levine syndrome
    • Nodofascicular pathway
    More Differentials
  • Guidelines

    • 2023 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation
    • 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
    More Guidelines
  • Patient information

    Atrial fibrillation

    More Patient information
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