Wolff-Parkinson-White syndrome (Louis Wolff)

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A cardiac pre-excitation syndrome in which normal sinoatrial impulses are conducted to the ventricles both by way of the atrioventricular node and by an abnormal pathway.

Description

A cardiac pre-excitation syndrome in which normal sinoatrial impulses are conducted to the ventricles both by way of the atrioventricular node and by an abnormal pathway. The atrial impulses thus pre-excite the ventricles via accessory bypass fibres called the Bundle of Kent, so that impulses reach the ventricles before those conducted by the normal His-Purkinje conducting system. Bundle branch block with a short P-R interval and a long QRS interval are the principal feature of this syndrome. The P-R interval is less than 0.12 seconds and the QRS complex contains an initial slur, called the delta wave, that broadens the complex. Supraventricular tachyardia, sometimes causing potentially fatal decreased cardiac output, may occur. Presents in childhood and is most common in children with congenital heart disease, especially Ebstein's anomaly. The syndrome may occur in an otherwise normal heart. Most patients asymptomatic.

The anomaly, complicated by mitral stenosis, was first described by Frank Norman Wilson (1890-1952) in 1915. An affected student, aged 19 years, was published by Wedd in 1921. Wolff, Parkinson and White alluded to these two descriptions when they described the disorder in 1930. The original article by these three authors contained an account of a form of bundle branch block in 11 healthy young adults who were subject to episodes of paroxysmal tachyardia. The relative contributions of the authors is uncertain.; one patient had been seen at the London Hospital, while the majority of the others were examined in Boston.

It turned out to be comparatively common and numerous reports followed; the triple eponym enjoyed immediate favour and it has continued to be widely accepted. With the accumulation of reports, it has become evident that the Wolff-Parkinson-White syndrome is very heterogeneous. It can exist with or without concomitant such as structural cardiac malformations and cardiomyelopathy and the isolated form is often familial. In 1959 Harnischfeger drew attention to hereditary occurrence, and in 1978 Gillette and colleagues proposed that the condition had an autosomal dominant mode of inheritance. The concept of autosomal dominant inheritance in pre-excitation and accessory atrioventricular pathways in the context of the syndrome was introduced in 1987 by Vidaillet and colleagues.

The syndrome was originally described with the clinical phenomenon of paroxysmal tachycardias. No tachycardias: no WPW-syndrome.

We thank Martin Lehn, Germany, for information submitted.

Bibliography

  • F. N. Wilson:
    A case in which the vagus influenced the form of the ventricular complex of the electrocardiogram.
    Archives of Internal Medicine, Chicago, 1915, 16: 1008-1027.
  • A. M. Wedd:
    Paroxysmal tachyardia.
    Archives of Internal Medicine, Chicago, 1921, 27: 571-590.
  • L. Wolff, J. Parkinson, P. D. White:
    Bundle-branch block with short P-R interval in healthy young people prone to paroxysmal tachyardia.
    American Heart Journal, St. Louis, 1930, 5: 685.
  • W. W. Harnischfeger:
    Hereditary occurrence of the pre-excitation (Wolff-Parkinson-White) syndrome with re-entry mechanisms and concealed conduction.
    Circulation, Dallas, Texas, 1959, 19: 28-40.
  • R. G. Schneider:
    Familial occurrence of Wolff-Parkinson-White syndrome.
    American Heart Journal, St. Louis, 1969, 78: 34-36.
  • P. C. Gillette, D. G. McNamara:
    A proposed autosomal dominant method of inheritance of the Wolff-Parkinson-White syndrome and supraventricular tachyardia.
    Journal of Pediatrics, St. Louis, 1978, 93: 257-258.
  • H. J. Vidaillet, J. C. Pressley, E. Henke, F.E. Harrell Jr., L. D. German:
    Familial occurrence of accessory atrioventricular pathways.
    New England Journal of Medicine, Boston, 1987, 317: 65-69.

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