Clinical Approach to Symptomatic and Asymptomatic Patients with Ventricular Pre-excitation

摘要

Ventricular pre-excitation is the hallmark of its presence, often referred to as Wolff-Parkinson-White (WPW) pattern, characterized by the short atrioventricular (AV) activation, short PR, and the slurred initial saltatory V conduction at the insertion of the accessory pathway (AP), the delta wave. Its prevalence varies between 1 to 3 cases in 1000 individuals increasing to 5.5 cases per 1000 population among first-degree relatives of an index case of WPW. Pre-excitation could be always present in sinus rhythm (SR) or become obvious during faster higher rates because of physiologic causes (eg, sinus tachycardia) or pathologic causes (eg, atrial fibrillation AF, atrial flutter AFL, or atrial tachycardia AT). Presence and type of symptoms, together with observations on spontaneous appearance and disappearance of pre-excitation, are important clinical observations of fundamental relevance in guiding the management of this condition.