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Experts release clinical practice guidelines for management of Wolff-Parkinson-White syndrome
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BOSTON — The Pediatric and Congenital Electrophysiology Society and the Heart Rhythm Society have released a first-of-its-kind clinical practice guideline for the evaluation and management of asymptomatic, young patients with Wolff-Parkinson-White electrocardiographic pattern.
Patients may be asymptomatic despite having an electrocardiogram with a Wolff-Parkinson-White (WPW) pattern. According to the consensus statement, it is estimated to occur in one to three people per 1,000. Identification of the truly asymptomatic patient with WPW is difficult, but it is estimated that approximately 65% of adolescents with a WPW pattern on resting ECGs are asymptomatic.
“Until now, there have been no specific guidelines addressing risk stratification in the asymptomatic, young child with Wolff-Parkinson-White [syndrome],” task force chairman Mitchell I. Cohen, MD, FACC, FHRS, said during a press conference at the Heart Rhythm Society Scientific Sessions.
The consensus statement is directed to all health care professionals who treat young patients aged 8 to 21 years with WPW. The writing committee recommends the following six evidence-based recommended practices for asymptomatic, young patients with a WPW electrocardiographic pattern.
- When the patient is old enough to comply, perform an exercise stress test if the patient exhibits persistent pre-excitation.
- In patients with intermittent pre-excitation, establish oversight by cardiologists who should provide counseling and symptom awareness.
- Perform a diagnostic transesophageal or intracardiac electrophysiology study on patients whose noninvasive testing shows persistent or uncertain loss of pre-excitation. The physician may recommend an ablation or continued awareness and observation for symptoms depending on results of the electrophysiology study.
- Patients with WPW and structural heart disease are at risk for both atrial tachycardia and atrioventricular reciprocating tachycardia and should consider ablation.
- Asymptomatic patients with WPW and ventricular dysfunction secondary to dyssynchronous contractions may consider ablation.
- Recommended by the American Heart Association guidelines, patients with WPW may be prescribed attention-deficit disorder medications.
The goal of the document is to provide helpful clinical guidelines for all health care professionals involved in the treatment of an asymptomatic, young patient with WPW, said Cohen, who is section chief of pediatric cardiology and director of pediatric electrophysiology and pacing at Phoenix Children’s Hospital.
“We felt we could provide all clinicians who treat adolescents with guidance, whether it’s the emergency room physician or the family physician,” Cohen, who is also clinical associate professor at University of Arizona School of Medicine, said in a press release. “Taking a ‘wait-and-see approach’ is not the answer.”
The statement is slated for publication in the June issue of HeartRhythm.
For more information:
- Cohen M. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White electrocardiographic pattern. Presented at: the Heart Rhythm Society’s 33rd Annual Scientific Sessions; May 9-12, 2012; Boston.
Disclosure: Dr. Cohen reports no relevant financial disclosures.