Evaluation and Management of Wolff-Parkinson-White in Athletes

Abstract

Context:Wolff-Parkinson-White (WPW) is a cardiac conduction system disorder characterized by abnormal accessory conduction pathways between the atria and the ventricles. Symptomatic patients classically present with palpitations, presyncope, or syncope that results from supraventricular tachycardia. While rare, sudden cardiac death may be the first manifestation of underlying disease and occurs more frequently in exercising individuals.Evidence Acquisition:Medline and PubMed databases were evaluated through 2012, with the following keywords: WPW, Wolff-Parkinson-White, pre-excitation, sudden cardiac death, risk stratification, and athletes. Selected articles identified through the primary search, along with relevant references from those articles, were reviewed for pertinent clinical information regarding the identification, evaluation, risk stratification, and management of WPW as they pertained to the care of athletes.Study Design:Systematic review.Level of Evidence:Level 1.Results:Diagnosis of WPW is confirmed by characteristic electrocardiogram changes, which include a delta wave, short PR interval, and widened QRS complex. Utilization of the electrocardiogram as part of the preparticipation physical evaluation may allow for early identification of asymptomatic individuals with a WPW pattern. Risk stratification techniques identify individuals at risk for malignant arrhythmias who may be candidates for curative therapy through transcatheter ablation.Conclusion:WPW accounts for at least 1% of sudden death in athletes and has a prevalence of at least 1 to 4.5 per 1000 children and adults. The risk of lethal arrhythmia appears to be higher in asymptomatic children than in adults, and sudden cardiac death is often the sentinel event. The athlete with WPW should be evaluated for symptoms and the presence of intermittent or persistent pre-excitation, which dictates further consultation, treatment, and monitoring strategies as well as return to play.

Update: Causes and symptoms of sudden cardiac death in young athletes

“…In those with a structurally abnormal hearts, the most common findings were HCM (251, 24%) and CAA (119, 11%). Several other cardiac diseases each accounted for less than 5% of the total, including myocarditis (41), ARVDC (30) [4]. Over the 10-year period, 182 SDs occurred (ages 20 ± 1.7; 85% males; 64% white) with 64 due to SCD (6/year) that occurred during organized athletic activity.…”

“…Rao and colleagues scanned Medline and PubMed through 2012, with the following keywords: WPW, Wolff-Parkinson-White, pre-excitation, sudden cardiac death, risk stratification, and athletes [30]. They selected key articles identified through their primary search and concluded that WPW accounts for at minimum 1% of sudden death in athletes and has a prevalence of at least 1 to 4.5 per 1000 children and adults.…”

Management of Wolff–Parkinson–White syndrome in athletes of youth sports schools on the example of two clinical cases

“…Вольфа-Паркинсона-Уайта (ВПУ) впервые был описан в 1930 г. в журнале The American Heart Journal, где были представлены электрокардиограммы (ЭКГ) 11 пациентов с укороченным интервалом P-R, изменением комплекса QRS по типу блокады ножки пучка Гиса и наличием приступов тахикардии (суправентрикулярной тахикардии (СВТ) или фибрилляции предсердий (ФП)), причем у больных не было других заболеваний сердца [1]. Вскоре после этого электрофизиологами была установлена взаимосвязь между наличием дополнительных путей проведения (ДПП) и развитием СВТ по механизму риентри.…”

“…Вскоре после этого электрофизиологами была установлена взаимосвязь между наличием дополнительных путей проведения (ДПП) и развитием СВТ по механизму риентри. Однако лишь спустя 40 лет было подтверждено, что механизм внезапной сердечной смерти (ВСС) при синдроме ВПУ связан с высокой проводимостью при развитии ФП [1].…”

Should Electrocardiograms Be Part of the Preparticipation Physical Examination?

“…Likewise, Wolf‐Parkinson‐White (WPW) can be risk stratified and high‐risk pathways ablated with expedient return to play [33]. Clearly, many of the most common conditions detected by ECG benefit from early identification and management.…”