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de Alencar Neto JN, Sakai MH, de Almeida Neto RG, Scheffer MK, Alencar E Silva GPS, Cirenza C, de Paola AAV. EPM algorithm: A stepwise approach to accessory pathway localization in ventricular pre-excitation. J Electrocardiol 2024; 84:1-8. [PMID: 38430664 DOI: 10.1016/j.jelectrocard.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/05/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Accurate estimation of accessory pathway (AP) localization in patients with ventricular pre-excitation or Wolff-Parkinson-White (WPW) syndrome remains a diagnostic challenge. Existing algorithms have contributed significantly to this area, but alternative algorithms can offer additional perspectives and approaches to AP localization. OBJECTIVE This study introduces and evaluates the diagnostic accuracy of the EPM algorithm in AP localization, comparing it with established algorithms Arruda and EASY. METHODS A retrospective analysis was conducted on 138 patients from Hospital São Paulo who underwent catheter ablation. Three blinded examiners assessed the EPM algorithm's diagnostic accuracy against the Arruda and EASY algorithms. The gold standard for comparison was the radioscopic position of the AP where radiofrequency ablation led to pre-excitation disappearance on the ECG. RESULTS EPM showed a diagnostic accuracy of 51.45%, closely aligning with Arruda (53.29%) and EASY (44.69%). Adjacency accuracy for EPM was 70.67%, with Arruda at 66.18% and EASY at 72.22%. Sensitivity for EPM in distinguishing left vs. right APs was 95.73%, with a specificity of 74.33%. For identifying septal vs. lateral right APs, EPM sensitivity was 82.79% with a specificity of 46.15%. These measures were comparable to those of Arruda and EASY. Inter-observer variability was excellent for EPM, with Kappa statistics over 0.9. CONCLUSION The EPM algorithm emerges as a reliable tool for AP localization, offering a systematic approach beneficial for therapeutic decision-making in electrophysiology. Its comparable diagnostic accuracy and excellent inter-observer variability underscore its potential clinical applicability. Future research may further validate its efficacy in a broader clinical setting.
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Affiliation(s)
- José Nunes de Alencar Neto
- Tele-Electrocardiography Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil.
| | - Marcel Henrique Sakai
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
| | | | - Matheus Kiszka Scheffer
- Tele-Electrocardiography Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Claudio Cirenza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
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Vătășescu RG, Paja CS, Șuș I, Cainap S, Moisa ȘM, Cinteză EE. Wolf-Parkinson-White Syndrome: Diagnosis, Risk Assessment, and Therapy-An Update. Diagnostics (Basel) 2024; 14:296. [PMID: 38337810 PMCID: PMC10855590 DOI: 10.3390/diagnostics14030296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Wolf-Parkinson-White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1-0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias.
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Affiliation(s)
- Radu Gabriel Vătășescu
- Cardiology Department, Clinic Emergency Hospital, 014461 Bucharest, Romania;
- 4th Department—Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
| | | | - Ioana Șuș
- Emergency Institute for Cardiovascular Disease and Transplantation, 540136 Tirgu Mures, Romania;
| | - Simona Cainap
- 8th Department—“Mother and Child”, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400012 Cluj-Napoca, Romania;
- 2nd Pediatric Department, Clinical Children Hospital, 400177 Cluj-Napoca, Romania
| | - Ștefana María Moisa
- Department of Pediatrics, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Eliza Elena Cinteză
- 4th Department—Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Interventional Cardiology Compartment, Marie Sklodowska Curie Children Emergency Hospital, 077120 Bucharest, Romania
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Pærregaard MM, Hartmann J, Sillesen AS, Pihl C, Dannesbo S, Kock TO, Pietersen A, Raja AA, Iversen KK, Bundgaard H, Christensen AH. The Wolff-Parkinson-White pattern in neonates: results from a large population-based cohort study. Europace 2023; 25:euad165. [PMID: 37465966 PMCID: PMC10354624 DOI: 10.1093/europace/euad165] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/17/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Wolff-Parkinson-White (WPW) syndrome is a conduction disorder characterized by an accessory electrical pathway between the atria and ventricles, which may predispose to supraventricular tachycardia (SVT) and sudden cardiac death. It can be seen as an isolated finding or associated with structural heart disease. Our aims were to determine the prevalence of a WPW pattern in a large and unselected cohort of neonates and to describe the electro- and echocardiographic characteristics as well as the natural history during early childhood. METHODS AND RESULTS Electrocardiograms and echocardiograms of neonates (aged 0-30 days) from a large, prospective, population-based cohort study were included. Neonates with a WPW pattern were identified and matched 1:4 to controls. Localization of the accessory pathway was assessed by different algorithms. Among 17 489 neonates, we identified 17 (76% boys) with a WPW pattern consistent with a prevalence of 0.1%. One neonate had moderate mitral regurgitation while other echocardiographic parameters were similar between cases and controls (all P > 0.05). The accessory pathways were primarily predicted to be left-sided. At follow-up (available in 14/17 children; mean age 3.2 years) the pre-excitation pattern persisted in only four of the children and none of the children had experienced any episodes of SVT. CONCLUSION The prevalence of a WPW pattern in our cohort of unselected neonates was 0.1%. The WPW pattern was more frequent in boys and generally not associated with structural heart disease, and the accessory pathways were primarily left-sided. At follow-up, the WPW pattern had disappeared in most of the children suggesting either an intermittent nature or that normalization occurs. CLINICAL TRIAL REGISTRATION Copenhagen Baby Heart, NCT02753348.
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Affiliation(s)
- Maria Munk Pærregaard
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Joachim Hartmann
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Christian Pihl
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Sofie Dannesbo
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
| | - Thilde Olivia Kock
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Adrian Pietersen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, Herlev–Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Copenhagen, Denmark
- Department of Cardiology, The Capital Regions Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
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Accuracy of Algorithms Predicting Accessory Pathway Localization in Pediatric Patients with Wolff-Parkinson-White Syndrome. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121962. [PMID: 36553406 PMCID: PMC9776491 DOI: 10.3390/children9121962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
We aimed to assess the accuracy of determining accessory pathway (AP) localization from 12 lead ECG tracings by applying 12 different algorithms in pediatric patients diagnosed with Wolff-Parkinson-White syndrome. We compared algorithm accuracy in electrophysiologic study ECG tracings with full preexcitation and resting ECG tracings. The assessing pediatric cardiologists were blinded regarding EP study results on AP localization. For exact AP location, the algorithms published by D'Avila et al. and Boersma et al. yielded the highest accuracy (58%). Distinguishing laterality, the median accuracy for predicting left or right-sided APs was 74%, while for septal APs it was 68%. We conclude that algorithms predicting AP location in pediatric patients with Wolff-Parkinson-White syndrome show low accuracy for exact AP localization. For laterality, however, accuracy was significantly higher.
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Bera D, Mukherjee SS, Halder A, Ray A. Inferior lead QRS discordance on surface electrocardiogram predicting right anterior accessory pathways: A simplified approach. J Cardiovasc Electrophysiol 2022; 33:1909-1910. [PMID: 35710697 DOI: 10.1111/jce.15603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Debabrata Bera
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, West Bengal, India
| | - Sanjeev S Mukherjee
- Department of Cardiology, Medica Superspeciality, Kolkata, West Bengal, India
| | - Antareep Halder
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, West Bengal, India
| | - Adrita Ray
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, West Bengal, India
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Kumar S, Thomas GR. Positive QRS complex in limb lead 2 with negative QRS in lead 3 on surface electrocardiogram is not indicative of a right sided accessory pathway. J Cardiovasc Electrophysiol 2022; 33:1908. [PMID: 35710980 DOI: 10.1111/jce.15602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sharath Kumar
- Division of Cardiology, Department of Medicine, Halifax Infirmary, Halifax, Nova Scotia, Canada
| | - Garry R Thomas
- Division of Cardiology, Department of Medicine, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Nayfeh M, Refaat MM. Is there a need for a novel algorithm for accessory pathways localization? J Cardiovasc Electrophysiol 2022; 33:962-965. [PMID: 35175658 DOI: 10.1111/jce.15414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
Wolff Parkinson White Syndrome (WPW) affects between 0.1% and 0.2% of the population, causes morbidity due to supraventricular tachycardia (SVT) and can lead to sudden cardiac arrest [1-3]. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Malek Nayfeh
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Bera D, Mukherjee SS, Majumder S, Sikdar S, Dasgupta K, Kar A, Kathuria S, Sarkar R. Positive QRS complex in limb lead 2 with negative QRS in lead 3 on surface electrocardiogram: A novel predictor for anterior location of right‐sided accessory pathways (10 to 1 o’clock on tricuspid annulus). J Cardiovasc Electrophysiol 2022; 33:953-961. [PMID: 35175685 DOI: 10.1111/jce.15418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Ayan Kar
- Dept of Cardiology, RTIICS Kolkata India
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9
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Nishimori M, Kiuchi K, Nishimura K, Kusano K, Yoshida A, Adachi K, Hirayama Y, Miyazaki Y, Fujiwara R, Sommer P, El Hamriti M, Imada H, Takemoto M, Takami M, Shinohara M, Toh R, Fukuzawa K, Hirata KI. Accessory pathway analysis using a multimodal deep learning model. Sci Rep 2021; 11:8045. [PMID: 33850245 PMCID: PMC8044112 DOI: 10.1038/s41598-021-87631-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/28/2021] [Indexed: 11/15/2022] Open
Abstract
Cardiac accessory pathways (APs) in Wolff-Parkinson-White (WPW) syndrome are conventionally diagnosed with decision tree algorithms; however, there are problems with clinical usage. We assessed the efficacy of the artificial intelligence model using electrocardiography (ECG) and chest X-rays to identify the location of APs. We retrospectively used ECG and chest X-rays to analyse 206 patients with WPW syndrome. Each AP location was defined by an electrophysiological study and divided into four classifications. We developed a deep learning model to classify AP locations and compared the accuracy with that of conventional algorithms. Moreover, 1519 chest X-ray samples from other datasets were used for prior learning, and the combined chest X-ray image and ECG data were put into the previous model to evaluate whether the accuracy improved. The convolutional neural network (CNN) model using ECG data was significantly more accurate than the conventional tree algorithm. In the multimodal model, which implemented input from the combined ECG and chest X-ray data, the accuracy was significantly improved. Deep learning with a combination of ECG and chest X-ray data could effectively identify the AP location, which may be a novel deep learning model for a multimodal model.
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Affiliation(s)
- Makoto Nishimori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Japan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Japan.
| | - Kunihiro Nishimura
- Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | | | | | | | - Philipp Sommer
- Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Bochum, Germany
| | - Mustapha El Hamriti
- Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Bochum, Germany
| | | | - Makoto Takemoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Japan
| | - Masakazu Shinohara
- Division of Epidemiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryuji Toh
- Division of Evidence-Based Labolatory Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Japan
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Stec PJ, Chrabąszcz M, Ujda M, Krawczykiewicz R, Śledź J, Stec S. Catheter ablation of complex arrhythmic anomalies: Bayes syndrome, Wolff-Parkinson-White syndrome, atrial and dilated cardiomyopathy. HeartRhythm Case Rep 2020; 5:476-479. [PMID: 31934545 PMCID: PMC6951312 DOI: 10.1016/j.hrcr.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Piotr J Stec
- Specialist Hospital in Stalowa Wola, Stalowa Wola, Poland
| | | | - Marek Ujda
- Specialist Hospital in Stalowa Wola, Stalowa Wola, Poland
| | | | | | - Sebastian Stec
- ELMedica EP-Network, Kielce, Poland.,Medinice Research and Development Centre, Aeropolis-Jasionka, Rzeszow, Poland
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Management of asymptomatic ventricular preexcitation. Indian Pacing Electrophysiol J 2019; 19:232-239. [PMID: 31669128 PMCID: PMC6904806 DOI: 10.1016/j.ipej.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/19/2019] [Indexed: 11/24/2022] Open
Abstract
An incidental discovery of Wolff Parkinson White (WPW) pattern on the electrocardiogram (ECG) is not an infrequent finding facing the physician. Most patients discovered incidentally are asymptomatic and it is hard to justify further management of such patients given the time-honored adage to “first do no harm.” However, this finding does have implications. This article is an attempt to guide clinicians about this important issue that is often faced in the office.
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