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Asymptomatic Wolff-Parkinson-White Syndrome: An Ounce of Prevention Is Worth the Risk of Cure

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

With increased electrocardiogram screening, asymptomatic preexcitation has become more prevalent. Historically, the asymptomatic-symptomatic dichotomy has directed management. This approach warrants scrutiny, as asymptomatic Wolff-Parkinson-White (WPW) syndrome is not without risk. Children may be unreliable symptom reporters, have atypical arrhythmia symptoms, yet have years to become symptomatic.

Recent Findings

In a large WPW study, symptomatic patients were more likely to undergo ablation than asymptomatic patients, yet, except for symptoms, there were no differences in clinical or electrophysiology study (EPS) characteristics. Present data confirm real risk in asymptomatic WPW—sudden death can be the first symptom. Although malignant arrhythmias correlate better with EPS risk stratification than with symptoms, EPS data are imperfect predictors.

Summary

Unlike adults with WPW, children have yet to prove survivorship. Asymptomatic children must be treated differently than adults. Sudden death risk is low but front-loaded in the young. An aggressive approach to asymptomatic WPW is warranted in this era of highly successful, low-risk catheter ablations.

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  1. Primary Children’s Hospital, The University of Utah, 84112, Salt Lake City, UT, USA

    Susan P. Etheridge, Lindsey Gakenheimer-Smith, S. Yukiko Asaki & Mary Niu

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Susan P. Etheridge reports consulting fees from Spaulding Research, payment or honoraria from UpToDate (for chapter writing), and Vice President SADS Foundation-Etheridge (not paid). The other authors declare that they have no conflict of interest.

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Etheridge, S.P., Gakenheimer-Smith, L., Asaki, S.Y. et al. Asymptomatic Wolff-Parkinson-White Syndrome: An Ounce of Prevention Is Worth the Risk of Cure. Curr Cardiol Rep 25, 543–551 (2023). https://doi.org/10.1007/s11886-023-01879-6

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