Wolff-Parkinson-White Syndrome

In patients with the Wolff-Parkinson-White syndrome, atrial fibrillation can be lethal. Longitudinal natural history studies suggest that these patients have a lifetime risk of sudden death of about 4%. Although this risk is relatively low, the combination of this risk and the morbidity associated with recurrent cardiac arrhythmias has justified the widespread use of catheter ablation therapy to eliminate accessory pathway conduction. The efficacy of catheter ablation therapy is about 90% to 95%, and the procedure is associated with a low morbidity rate. Pharmacologic therapy is reserved for those rare patients who do not respond to catheter ablation or do not wish to undergo an invasive procedure. Although surgical therapy has been used to eliminate the Wolff-Parkinson-White syndrome definitively, patients now rarely undergo surgical ablation. The most important steps in the management of a patient with the Wolff-Parkinson-White syndrome are the recognition of the condition and subsequent referral of the patient to an electrophysiologist for curative catheter ablation.