2012 PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern

May 10, 2012—The expert consensus statement provides first-of-its-kind clinical practice guidelines on the evaluation and management of asymptomatic young patients with a Wolff-Parkinson-White (WPW) electrocardiographic pattern. This is also the first collaboration between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS).


Patients with the WPW syndrome may have palpitations, dizziness, or fainting from an extra electrical pathway (circuit) in the heart. The condition can lead to episodes of rapid heart rate, or tachycardia. Patients may be asymptomatic despite having an electrocardiogram with a WPW pattern. According to the consensus statement, it is estimated to occur in anywhere from one to three people per 1,000. Identification of the truly asymptomatic patient with WPW is difficult, but it is estimated that approximately 65 percent of adolescents with a WPW pattern on resting electrocardiograms (ECGs) are asymptomatic.

As ECGs have become more common for screening prior to sports participation, medical procedures, and initiation of some medications, the number of asymptomatic individuals identified to have WPW, especially children and adolescents, has increased. While catheter ablation is best to eliminate the risk of sudden death in the asymptomatic child with WPW, optimum management of these patients is unclear.

Members from PACES and HRS formed a committee that performed a formal literature review and then weighed the strength of the evidence for or against an observational strategy or a particular procedure in the evaluation and management of asymptomatic patients with WPW. The resulting consensus statement is directed at all health care professionals who treat young patients with WPW. For the specific purpose of this statement, the young patient is defined as being between eight and 21 years of age, an age span routinely cared for by pediatricians and pediatric cardiologists.