eMedicine Specialties > Emergency Medicine > Cardiovascular

Wolff-Parkinson-White Syndrome: Follow-up

Author: Thomas J Hemingway, MD, BS, Attending Physician, Department of Emergency Medicine, Wilcox Memorial Hospital
Coauthor(s): Eric Alexander Savitsky, MD, Associate Clinical Professor of Medicine, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles Medical Center; Mel Herbert, MD, MBBS, Assistant Professor of Medicine and Nursing, Department of Emergency Medicine, Olive View-University of California at Los Angeles Medical Center
Contributor Information and Disclosures

Updated: Aug 19, 2008

Follow-up

Further Inpatient Care

  • Arrange consultation with a cardiologist for patients admitted with Wolff-Parkinson-White (WPW) syndrome because these patients are at high risk of sudden death if they develop AFib. Those who can be treated and discharged should also have urgent cardiology follow-up. One should consider radiofrequency ablation of the accessory pathway in all patients.

Further Outpatient Care

  • Follow-up with a cardiologist and cardiac electrophysiologist is recommended in the patient with any worrisome features (eg, syncope, significant symptomatic tachyarrhythmias, uncertain diagnosis in those with wide-complex tachycardia, associated structural heart disease, WPW syndrome with a family history of sudden death, recurrent atrial fibrillation or flutter).

Inpatient & Outpatient Medications

  • Ongoing therapy of patients with WPW syndrome is generally interventional (radiofrequency ablation). Those patients whom receive ongoing pharmacologic therapy should do so only under the supervision of an experienced cardiologist.

Transfer

  • In patients whom have experienced worrisome features (eg, syncope, significant symptomatic tachyarrhythmias, uncertain diagnosis in those with wide-complex tachycardia, associated structural heart disease, WPW syndrome with a family history of sudden death, recurrent atrial fibrillation or flutter) whom cannot achieve an urgent cardiologist and/or cardiac electrophysiologist consultation, transfer should be considered to expedite this process.

Prognosis

  • Patients with WPW syndrome have an excellent prognosis when treated with radiofrequency ablation of the accessory pathway.

Patient Education

  • Education is the most important aspect of outpatient care for patients with WPW. Urge patients to carry a sample ECG in sinus rhythm and a medical identification bracelet in case of cardiac arrest.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize this dysrhythmia and treatment with agents leading to deterioration (eg, beta-blockers, calcium channel blockers, digoxin) may lead to clinical deterioration and medicolegal vulnerability.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Griffith Tully, MD, to the development and writing of this article.



More on Wolff-Parkinson-White Syndrome

Overview: Wolff-Parkinson-White Syndrome
Differential Diagnoses & Workup: Wolff-Parkinson-White Syndrome
Treatment & Medication: Wolff-Parkinson-White Syndrome
Follow-up: Wolff-Parkinson-White Syndrome
References
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References

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Further Reading

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Keywords

Wolff-Parkinson-White syndrome, preexcitation syndrome, atrioventricular reentrant tachycardia, AVRT, AVNRT, atrioventricular nodal reentrant tachycardia, AV nodal reentrant tachycardia, WPW syndrome, paroxysmal supraventricular tachycardia, PSVT, supraventricular tachycardia, SVT, heart disease

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Contributor Information and Disclosures

Author

Thomas J Hemingway, MD, BS, Attending Physician, Department of Emergency Medicine, Wilcox Memorial Hospital
Thomas J Hemingway, MD, BS is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Eric Alexander Savitsky, MD, Associate Clinical Professor of Medicine, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles Medical Center
Eric Alexander Savitsky, MD is a member of the following medical societies: Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Mel Herbert, MD, MBBS, Assistant Professor of Medicine and Nursing, Department of Emergency Medicine, Olive View-University of California at Los Angeles Medical Center
Mel Herbert, MD, MBBS is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine
Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gary Setnik, MD, Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School
Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians
Disclosure: Intellicare Salary Management position; South Middlesex EMS Consortium Salary Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Schering  Honoraria Speaking and teaching

 
 
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