Risk stratification and management of arrhythmias in patients with Wolff–Parkinson–White syndrome

Abstract

Wolff-Parkinson-White (WPW) syndrome is a cardiac disorder characterized by an accessory pathway known as the bundle of Kent, which bypasses the atrioventricular node and predisposes patients to tachyarrhythmias, including supraventricular tachycardia and atrial fibrillation. The prevalence of WPW syndrome ranges from 0.1% to 0.5% globally, with a higher incidence in males and diagnosis typically occurring between ages 10 and 30. Although many individuals remain asymptomatic, WPW presents a risk of life-threatening arrhythmias, including sudden cardiac death, particularly when atrial fibrillation progresses to ventricular fibrillation (VF). Effective risk stratification is essential for managing WPW syndrome; this involves evaluating symptomatic presentation, accessory pathway properties, and underlying cardiac conditions using clinical, electrocardiographic, and electrophysiological data. Recent advances in risk stratification models enable clinicians to identify better patients at high risk for arrhythmia recurrence or sudden death, informing treatment strategies such as catheter ablation. This study emphasizes the importance of personalized risk assessment in guiding therapeutic decisions, minimizing unnecessary interventions, and improving outcomes. This review's novel contribution lies in its updated analysis of risk stratification models, which incorporates new research on the genetic and epidemiological factors influencing WPW syndrome. This analysis emphasizes the evolving role of catheter ablation as a first-line treatment for high-risk patients, demonstrating its potential to provide long-term arrhythmia control with minimal complications. Our findings underscore the necessity for ongoing post-ablation surveillance to monitor for recurrence and to optimize patient care, ultimately improving clinical outcomes.