Electrocardiographic findings in 67,375 asymptomatic subjects: IV. Wolff-Parkinson-White syndrome∗

doi:10.1016/0002-9149(60)90041-2

The American Journal of Cardiology

Volume 6, Issue 1, July 1960, Pages 108-129

https://doi.org/10.1016/0002-9149(60)90041-2 Get rights and content

Abstract

One hundred nine new cases of the WPW syndrome are presented. One hundred six were discovered as the result of an electrocardiographic survey of 67,375 asymptomatic healthy adult men producing an occurrence rate of 1.6 per thousand.

There was an equal distribution among the various age groups; none was thought to have underlying organic heart disease and the incidence of paroxysmal tachycardia was approximately 12 per cent.

The electrocardiographic characteristics, the instability of intraventricular excitation and the intermittent nature of the anomalous excitation are discussed.

The experimental production of normal excitation is discussed with particular reference to the effects of varying vagal tone at various levels of the conduction system and to the value of intravenous administration of atropine sulfate.

The vectorcardiographic characteristics are presented.

The variability and lability of the S-T segments and T waves are stressed with respect to both spontaneous changes and those following various maneuvers.

The probable congenital nature of the true WPW syndrome is stressed and the usual benign clinical nature discussed. This study casts serious doubt on the concept of an acquired WPW syndrome.

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Cited by (54)

Management of Asymptomatic Wolff-Parkinson-White Pattern by Pediatric Electrophysiologists
2019, Journal of Pediatrics
To determine the present-day approach of pediatric cardiac electrophysiologists to asymptomatic Wolff-Parkinson-White (WPW) pattern and to contrast to both published consensus statements and a similar survey.
A questionnaire was sent to 266 Pediatric and Congenital Electrophysiology Society physician members in 25 countries; 21 questions from the 2003 survey were repeated, with new questions added regarding risk stratification and decision making.
We received 113 responses from 13 countries, with responders having extensive electrophysiology experience (median 15 years [IQR 8.5-25 years]). Only 12 (11%) believed that intermittent pre-excitation and 37 (33%) that sudden loss of pre-excitation on exercise test were sufficient evidence of accessory pathway safety to avoid an invasive electrophysiology study. Optimal weight for electrophysiology study was 20 kg (IQR 18-22.5 kg), and 61% and 58% would then ablate all right-sided or left-sided accessory pathways, respectively, regardless of electrophysiological properties, whereas only 23% would ablate all septal accessory pathways (P < .001). Compared with 2003, respondents were more likely to consider inducible arrhythmia (77% vs 26%, P < .001) as sufficient indication alone for ablation.
In the context of recent literature regarding the reliability of risk-stratification tools, most operators are now performing electrophysiology study for asymptomatic Wolff-Parkinson-White regardless of noninvasive findings. Many will then proceed to default ablation of all accessory pathways distant from critical conduction structures.
PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease: Developed in partnership with the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS)Endorsed by the governing bodies of PACES, HRS, the American Academy of Pediatrics (AAP), the American Heart Association (AHA), and the Association for European Pediatric and Congenital Cardiology (AEPC)
2016, Heart Rhythm
Citation Excerpt :
The acute and chronic management of usual AVRT due to a typical concealed or retrograde-only AP is similar to AVNRT, and is addressed as such in these guidelines (see SVT recommendations above). The incidence of WPW pattern is 0.1% to 0.5% in the general population.73-75 A manifest AP can symptomatically present clinically in one of four ways: AVRT, AF/flutter, ventricular dysfunction due to asynchronous contraction through the AP, or sudden death.
Management of symptomatic Wolff-Parkinson-White syndrome in childhood
2013, Progress in Pediatric Cardiology
Citation Excerpt :
Septal connections may be more common among young patients [18,19]. The prevalence of Wolff–Parkinson–White syndrome in childhood is estimated to be 0.4–2.2 per 1000 individuals [8,20–23], and is more common among males [8,13,20,22,24–27]. First degree relatives of affected patients have an increased risk of preexcitation, estimated at 5.5 per 1000 [28].
The term “ventricular preexcitation” or “preexcitation” refers to the presence of a delta wave and short PR interval on electrocardiogram (ECG) during normal sinus rhythm. The Wolff–Parkinson–White (WPW) syndrome refers to preexcitation during sinus rhythm, in association with episodes of supraventricular tachycardia (SVT). The delta wave represents extra-nodal conduction via an accessory connection located along the atrioventricular groove or the septal region, and this substrate can support atrioventricular reentrant tachycardia. Patients with Wolff–Parkinson–White syndrome may experience symptoms of palpitations, dizziness, syncope, or sudden cardiac arrest related to supraventricular tachycardia; infants may present with congestive heart failure. Catastrophic symptoms such as cardiac arrest or sudden death may be triggered from atrial fibrillation with rapid antegrade conduction to the ventricle via the accessory connection, resulting in ventricular fibrillation [1], [2], [3], [4]; this risk is likely higher in patients in the first three decades of life [4], [5]. Sudden cardiac arrest as the initial symptom may be more common in younger patients [2], [4], [6]; for this reason, appropriate evaluation and management of the young patient with preexcitation is essential.
PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern: Developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS).
2012, Heart Rhythm
Citation Excerpt :
The natural history of the asymptomatic patient with WPW is extrapolated from data on symptomatic patients and from asymptomatic patients discovered by fortuitous ECG testing. In large-scale general population studies involving children and adults, the prevalence of WPW is estimated to be 1–3 in 1000 individuals.7–13 Familial studies have shown an incidence of 5.5 in 1000 among first-degree relatives following an index case of WPW.14
Occurrence of intermittent Wolff-Parkinson-White syndrome during intravenous sedation
2008, Journal of Clinical Anesthesia
Citation Excerpt :
WPW syndrome frequently causes paroxysmal supraventricular tachycardia and/or atrial fibrillation. The prevalence of the WPW ECG pattern in the general population is estimated to be 0.1% to 0.3% [1-3]. Intermittent loss of the delta wave has been observed in some patients with WPW syndrome.
Patients with intermittent Wolff-Parkinson-White (WPW) syndrome, defined as intermittent loss of the delta waves, can show occasional conduction through the accessory pathway. WPW syndrome often causes paroxysmal supraventricular tachycardia or atrial fibrillation. However, it may be difficult to identify the abnormalities preoperatively because of their only intermittent occurrence. We report a case in which exogenously administered epinephrine and an autonomic imbalance may have precipitated the abrupt occurrence and disappearance of the delta waves.
Supraventricular tachycardia during spinal anaesthesia for caesarean section
2001, International Journal of Obstetric Anesthesia
A woman of 40 weeks’ gestation, who was apparently previously healthy, required emergency caesarean section after a failed vacuum delivery. While under spinal anaesthesia she developed a supraventricular tachycardia of unknown origin. Intravenous verapamil resulted in a conversion to sinus rhythm. Further investigations confirmed Wolff-Parkinson-White syndrome, for which she required ablation therapy. Appropriate methods of cardioversion in this clinical setting are discussed.

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Symposium on cardiology in aviationElectrocardiographic findings in 67,375 asymptomatic subjects: IV. Wolff-Parkinson-White syndrome∗

Abstract

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Arch. Inst. cardiol. Mexico

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. J. Cardiol.

Am. J. Cardiol.

Am. Heart J.

Am. Heart J.

Am. J. Med.

Am. Heart J.

Pre-excitation. A cardiac abnormality

Acta med. scandinav.

Accelerated Conduction

A case in which the vagus influenced the form of the ventricular complex of the electrocardiogram

Arch. Int. Med.

Paroxysmal tachycardia with reference to normotopic tachycardia and the role of the extrinsic cardiac nerves

Arch. Int. Med.

Electrocardiographic changes in rheumatic carditis

Lancet

Bundle branch block. Four cases of intraventricular block showing some interesting and unusual clinical features

M. Clin. North America

Bundle branch block of vagal origin

Brit. M. J.

Über Elektrokardiogramme mit verkurzter Vorhof-Kammer-Distanz und positiven P-Zacken

Ztschr. Klin. Med.

Observations on the auriculo-ventricular junction of the mammalian heart

Quart. J. Exper. Physiol.

A morphologic study of the cardiac conduction system in ungulates, dogs and man. I. The sinoatrial node

Am. Heart J.

The theory of Kent. A histologic study of the normal atrioventricular communications of the human heart

Circulation

Recherches d'anatomie compareé et de pathologie experimentale sur les connexions hautes du jaisceau de His-Tawara

Cardiologia

Short P-R interval associated with a prolonged QRS complex—-a clinical and experimental study

Arch. Int. Med.

Anomalous atrioventricular excitation—-panel discussion

Ann. New York Acad. Sc.

Bundle branch block with short P-R interval in individuals without organic heart disease

Am. J. M. Sc.

The syndrome of short P-R interval, apparent bundle branch block and associated paroxysmal tachycardia

Brit. Heart J.

The syndrome of paroxysmal tachycardia with short P-R interval and prolonged QRS complex with report of two cases

Ann. Int. Med.

Short P-R interval, prolonged QRS complex (Wolff-Parkinson-White syndrome); report of 14 cases and a review of the literature

Ann. Int. Med.

Symposium on cardiology in aviation
Electrocardiographic findings in 67,375 asymptomatic subjects: IV. Wolff-Parkinson-White syndrome^∗