Wolff-Parkinson-White syndrome

Last reviewed: 2 Sep 2023
Last updated: 26 May 2023

Summary

Definition

History and exam

Key diagnostic factors

  • atrioventricular re-entrant tachycardia (AVRT)
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • 12-lead ECG
More 1st investigations to order

Investigations to consider

  • echo
  • treadmill exercise test
  • electrophysiology study
More investigations to consider

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 Biosense Webster, Abbott, and Boston Scientific.

Acknowledgements

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

Peer reviewers

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

    • 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
    • Guidelines for the management of atrial fibrillation
    More Guidelines
  • Patient leaflets

    Atrial fibrillation

    More Patient leaflets
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