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. 2014 Jul;6(4):326-32.
doi: 10.1177/1941738113509059.

Evaluation and management of wolff-Parkinson-white in athletes

Ashwin L Rao  1 , Jack C Salerno  2 , Irfan M Asif  3 , Jonathan A Drezner  1
Affiliations

Evaluation and management of wolff-Parkinson-white in athletes

Ashwin L Rao et al. Sports Health. 2014 Jul.

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.

Keywords: Wolff-Parkinson-White; athlete; athletic participation; pre-excitation; risk stratification; sudden cardiac death.

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Conflict of interest statement

The following author declared potential conflicts of interest: Irfan M. Asif, MD, is employed by the University of Tennesse, and received a Physicians Medical Grant from the University of Tennessee ($10,000) and Young Investigator Grant from the American Medical Society for Sports Medicine ($5,000).

Figures

Figure 1.
Figure 1.
Characteristic ECG findings in WPW. Note the presence of a short PR interval (<120 ms) and delta wave (slurred upstroke of the QRS complex). ECG, electrocardiogram.
Figure 2.
Figure 2.
ECG at initial preparticipation physical evaluation (preablation) demonstrates a WPW pattern. Red arrows identify the characteristic delta wave and short PR interval. ECG, electrocardiogram; WPW, Wolff-Parkinson-White.
Figure 3.
Figure 3.
Postablation ECG. WPW pattern has been extinguished. Note the absence of a delta wave and normalization of the PR interval. New T-wave inversion in the inferior leads is a result of the ablation therapy that typically resolves over time. ECG, electrocardiogram; WPW, Wolff-Parkinson-White.
Figure 4.
Figure 4.
WPW management algorithm. AF, atrial fibrillation; ECG, electrocardiogram; SPERRI, shortest pre-excited R-R interval; SVT, supraventricular tachycardia; WPW, Wolff-Parkinson-White.
See this image and copyright information in PMC

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