In a new issue, Hayrullah Alp, MD and colleagues from Necmettin Erbakan University, Meram School of Medicine Hospital, present a case of an infant referred to their clinic with severe Ebstein’s anomaly, ventricular communications, and Wolff-Parkinson-White (WPW) syndrome. EP Lab Digest® has featured several articles on WPW syndrome over the years.
The conduction anomaly known as WPW syndrome affects 0.1 to 0.2% of the population, and can be found in males and females. It can occur at any age, but is most often seen in childhood or in the third or fourth generation of life. Patients can be asymptomatic, have occasional episodes, or have episodes that require RF ablation. In October 2012, Deanne Wilk, RN and Jeffrey L. Williams, MD, MS, FACC, FHRS explained that WPW is one of a classification of preexcitation disorders that have been found to have a genetic component. New research has identified the gene (PRKAG2) with WPW associated with hypertrophic cardiomyopathy and conduction system disease. There may also be a glycogen and ion channel mutation in conjunction with the accessory pathways that are the hallmark of this syndrome. WPW syndrome is in extensive research to identify the components of the genetic mutation and its relation to other disease processes.
This February, Antonio Navarrete, MD, FACC, CCDS and Louis Janeira, MD reported on a case of WPW in a 23-year-old patient with a persistent left superior vena cava (PLSVC), the most frequent congenital thoracic vein abnormality. The patient was referred for catheter ablation of WPW with left-sided accessory pathway for recurrent presyncopal spells due to preexcited atrial fibrillation (AF). The authors wrote that the association between WPW and AF is well known, although the underlying basic mechanism is not totally understood, and that up to 30% of patients with WPW develop AF. In this particular case, Drs. Navarrete and Janeira performed only catheter ablation of WPW, and no further AF was documented in this patient at five-month follow-up (the PLSVC was a potential cause for the AF episodes). They concluded that when AF is documented in WPW patients with PLSVC, it is reasonable to target the accessory pathway as a first-line approach.
For more information on WPW, check out this sampling of other various articles in EP Lab Digest®:
• EP 101: What Preexcitation Wrought: Wolff-Parkinson-White
• What Is the Risk of Sudden Cardiac Arrest with a Decremental Atrio-fasicular Pathway?