An ECG of a 5-year-old girl shows Wolff-Parkinson-White syndrome. What investigations should she undergo and how is this condition managed?
- Wolff-Parkinson-White syndrome is a pre-excitation syndrome, a congenital atrioventricular re-entry circuit, which is abnormal conductive tissue between the atria and the ventricles.
- Symptomatically, it most commonly occurs in childhood and young adulthood and typically causes supraventricular tachycardias.
- The diagnosis is initially suggested by the clinical picture and ECG abnormalities, both of which may be quite variable.
- It is important to diagnose or exclude any possible contributing conditions, such as electrolyte disturbance, hyperthyroidism, cardiomyopathy, ischaemic heart disease or anaemia.
- Illicit drug use and alcohol abuse should be considered, especially in younger adults presenting with arrhythmias.
- Untreated prolonged arrhythmias may cause cardiac failure, especially in infants and the elderly.
- Investigations include monitoring, cardiac echocardiography and electrophysiological studies.
- Management includes medication to slow conduction through the atrioventricular node or through the accessory pathway, or radio-frequency ablation of the accessory pathway.
- Wide complex tachycardias should not be treated with negative inotropes (such as verapamil and flecainide) or atrioventricular node blockers (such as adenosine and digoxin) because of the risk of precipitating sudden death.