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

Endorsing Organizations

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