Initial Evaluation of Patients with the Wolff-Parkinson-White Syndrome

  • George J. Klein
  • Arjun D. Sharma
  • Simon Milstein


The classic electrocardiographic Wolff-Parkinson-White (WPW) pattern has been estimated to occur in 1 to 3 per 1,000 individuals [1]. Strictly speaking, only patients with a manifest delta wave and rapid-heart-beating should be considered as having WPW syndrome [2] 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) [5]. 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.


Atrial Fibrillation Ventricular Fibrillation Refractory Period Accessory Pathway Delta Wave 
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Copyright information

© Martinus Nijhoff Publishing 1986

Authors and Affiliations

  • George J. Klein
  • Arjun D. Sharma
  • Simon Milstein

There are no affiliations available

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