Initial Evaluation of Patients with the Wolff-Parkinson-White Syndrome
The classic electrocardiographic Wolff-Parkinson-White (WPW) pattern has been estimated to occur in 1 to 3 per 1,000 individuals . Strictly speaking, only patients with a manifest delta wave and rapid-heart-beating should be considered as having WPW syndrome  but it is now known that many patients with the underlying substrate for this syndrome — namely, the accessory atrioventricular pathway — have “concealed” accessory pathways and have normal PR intervals and QRS morphology as the pathways conduct only in the retrograde direction [3,4]. The spectrum of WPW patients includes those with a purely benign “cosmetic” delta wave, those with troublesome but not life-threatening paroxysmal tachycardia, and those with a potentially life-threatening arrhythmia (most often atrial fibrillation with a rapid ventricular response that could lead to ventricular fibrillation) . The evaluation of the patient with WPW syndrome depends a great deal on the clinical presentation. The main challenge to the physician is to find the relatively infrequent WPW patient who is at risk for a potentially lethal arrhythmia and to distinguish this patient from those that can be reassured or treated in a more methodical fashion with empirical drug trials.
KeywordsAtrial Fibrillation Ventricular Fibrillation Refractory Period Accessory Pathway Delta Wave
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