Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern
Publication Date: May 14, 2012
Last Updated: March 14, 2022
Recommendations
An exercise stress test, when the child is old enough to comply, is a reasonable component of the evaluation if the ambulatory ECG exhibits persistent preexcitation (Class IIA, Levels of Evidence B/C). ()
In patients with clear and abrupt loss of preexcitation at physiological heart rates, the accessory pathway properties pose a lower risk of sudden death. In children with subtle preexcitation the ECG and exercise test may be difficult to interpret.
(Level of Evidence: B/C)
701
Utilization of invasive risk stratification (transesophageal or intracardiac) to assess the shortest preexcited R-R interval in atrial fibrillation is reasonable in individuals whose noninvasive testing does not demonstrate clear and abrupt loss of preexcitation. ()
(Level of Evidence: B/C)
701
Young patients with a SPERRI 250 ms in atrial fibrillation are at increased risk for SCD. It is reasonable to consider catheter ablation in this group, taking into account the procedural risk factors based on the anatomical location of the pathway. ()
(Level of Evidence: B/C)
701
Young patients with a SPERRI >250 ms in atrial fibrillation are at lower risk for SCD, and it is reasonable to defer ablation. (C)
701
Ablation may be considered in these patients at the time of diagnostic study if the location of the pathway and/or patient characteristics do not suggest that ablation may incur an increased risk of adverse events, such as AV block or coronary artery injury. (C)
701
Young patients deemed to be at low risk might subsequently develop cardiovascular symptoms such as syncope or palpitations. These patients should then be considered symptomatic and may be eligible for catheter ablation procedures regardless of the prior assessment.
701
Asymptomatic patients with a WPW ECG pattern and structural heart disease are at risk for both atrial tachycardia and AV reciprocating tachycardia, which may result in unfavorable hemodynamics. Ablation may be considered regardless of the anterograde characteristics of the accessory pathway. (C)
701
Asymptomatic patients with a WPW ECG pattern and ventricular dysfunction secondary to dyssynchronous contractions may be considered for ablation, regardless of anterograde characteristics of the bypass tract. (C)
701
Asymptomatic patients with a WPW ECG pattern may be prescribed ADHD medications. This recommendation follows the American Heart Association Guidelines, which state that ADHD medications may be used in this setting after cardiac evaluation and with intermittent monitoring and supervision of a pediatric cardiologist.
701
Recommendation Grading
Overview
Title
Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern
Authoring Organization
Heart Rhythm Society
Endorsing Organizations
American Academy of Pediatrics
American College of Cardiology
American Heart Association
Heart Rhythm Society
Publication Month/Year
May 14, 2012
Last Updated Month/Year
August 21, 2023
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Document Objectives
To provide up to date clinical practice guidelines on the management of asymptomatic patients with Wolff Parkinson White electrocardiographic pattern.
Inclusion Criteria
Female, Male, Adolescent, Child
Health Care Settings
Hospital, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D014927 - Wolff-Parkinson-White Syndrome
Keywords
catheter ablation, ablation, arrhythmia