Recurrence and progression of Wolff-Parkinson-White syndrome in pediatric patient




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Wolff-Parkinson-White (WPW) syndrome is a rare cardiac condition characterized by ventricular pre-excitation leading to symptoms of arrhythmia and tachycardia with a risk for sudden cardiac death (SCD). WPW is uncommon in the general population and even less frequent in the pediatric population. Diagnosis of WPW is made by electrocardiogram (ECG) with the hallmark presentation of a short PR interval, widened QRS complex, and a slurred upstroke of the QRS complex known as a delta wave. Of the patients eliciting the WPW pattern, few will progress to a symptomatic state, known as WPW syndrome, and it is unknown what causes the transition from asymptomatic to symptomatic WPW. The case demonstrates WPW syndrome in a pediatric patient and identifies a potential cause for symptom development and progression in that population.

Case Information

A 16-year-old male presented with complaints of sudden onset episodes of palpitations and tachycardia with lightheadedness. The episodes occurred several times a month, lasting for a few seconds to an hour at a time before abruptly resolving. The symptoms appeared with actions such as bending over or getting up from a bent-over position. The patient reported having similar episodes of palpitations and tachycardia four years ago, which were less frequent, less noticeable, and subsequently self-resolved. At that time, the episodes occurred twice a month. The patient does not have a history of any other cardiac conditions.

An ECG was ordered to evaluate for supraventricular tachycardia. ECG findings revealed a shortened PR interval of 102 ms (normal is 120-200 ms), a widened QRS complex of 118 ms (normal is 80-100 ms), and a delta wave indicating pre-excitation from an accessory pathway. These results confirmed the diagnosis of WPW syndrome.

The patient underwent radiofrequency ablation therapy of a low-risk left lateral accessory pathway. Treatment was successful with the resolution of WPW abnormalities on ECG post-ablation therapy. The patient was allowed to return to activity one week after treatment and continues to be asymptomatic and without abnormalities on ECG four months after.


WPW syndrome is an uncommon condition symptomatically characterized by arrhythmias from ventricular preexcitation with the most dangerous associated risk of SCD. The patient underwent radiofrequency ablation therapy due to presentation with a recurrence of symptomatic episodes with increased frequency and progression. In this case, the patient fits the gender profile of WPW but developed symptoms at an unusual age. There is no clear evidence on why the patient's symptoms returned after four years with more frequency, severity, and noticeability. A probable explanation is that, in a pediatric patient, changes from puberty-related heart development and physical growth led to a progression of symptoms and a more apparent reflection of the delta wave on ECG. More research is needed to identify why symptoms reoccur or worsen and how this may impact the risk calculation for SCD in patients. If puberty is a trigger, pediatric patients must be monitored for WPW pattern on ECG and onset of symptoms for prompt delivery of treatment to avoid the risk of SCD.