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Editorials

WPW Pattern in the Asymptomatic Individual

Has Anything Changed?

George J. Klein, MD; Lorne J. Gula, MD; Andrew D. Krahn, MD; Allan C. Skanes, MD and Raymond Yee, MD

From the Department of Medicine, Division of Cardiology, University of Western Ontario, London, Ontario, Canada.

Correspondence to George J. Klein, MD, FRCPC, London Health Sciences Centre, Arrhythmia Service, 339 Windermere Rd, London, Ontario, N6A 5A5, Canada. E-mail gklein@uwo.ca

Key Words: Wolff-Parkinson-White syndrome • electrophysiology • tachyarrhythmias • ablation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The patient with the Wolff-Parkinson-White (WPW) ECG pattern has much in common with patients with other entities, such as long-QT syndrome and Brugada syndrome, which are associated with an identifying abnormality on ECG. All are relatively benign in the majority of afflicted individuals but nonetheless carry a risk of unexpected sudden death, which begs for some attempt at risk management. The WPW pattern differs from the others in that a highly effective curative procedure is available, albeit with some risk, leaving us with a decision to manage expectantly or intervene.

Article see p 102

The WPW pattern is relatively common and found in the range of 2 to 4 individuals per 1000,^1,2 the great majority of whom will never be aware of the issue unless it is discovered incidentally. The lifetime risk of mortality related to this in asymptomatic individuals can never be accurately known but has been estimated to be in the range of 1 per 1000 (0.1% annual risk).³This small risk of sudden death is thought to be more "front loaded" in the first part of life, with the majority of patients identified between the ages of approximately 10 to 40 years. The small hearts of normal infants and smaller children are probably more resistant to sustained atrial fibrillation (AF) or ventricular fibrillation (VF), whereas the risk in older individuals who have not had arrhythmia is attenuated by the tendency of accessory pathways to lose their arrhythmic functionality over time.^1,4 This relatively low mortality is supported by . . . [Full Text of this Article]

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