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First published online October 22, 2013

Evaluation and Management of Wolff-Parkinson-White in Athletes

Ashwin L. Rao, MD [email protected], Jack C. Salerno, MD, Irfan M. Asif, MD, and Jonathan A. Drezner, MDView all authors and affiliations
Volume 6, Issue 4
https://doi.org/10.1177/1941738113509059

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.

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Published In

Volume 6, Issue 4
Pages: 326 - 332
Article first published online: October 22, 2013
Issue published: July/August 2014

Keywords

  1. Wolff-Parkinson-White
  2. pre-excitation
  3. risk stratification
  4. athletic participation
  5. sudden cardiac death
  6. athlete

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© 2013 The Author(s).
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PubMed: 24982705

Authors

Affiliations

Ashwin L. Rao, MD*
Department of Family Medicine, University of Washington, Seattle, Washington
[email protected]
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Jack C. Salerno, MD
Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, Washington
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Irfan M. Asif, MD
Department of Family Medicine, University of Tennessee, Knoxville, Tennessee
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Jonathan A. Drezner, MD
Department of Family Medicine, University of Washington, Seattle, Washington
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Notes

*
Ashwin L. Rao, MD, University of Washington Sports Medicine Center, 3800 Montlake Blvd NE, Box 354060, Seattle, WA 98195 (e-mail: [email protected])

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