LAUSR

Much has been learned about the Wolff-Parkinson-White Syndrome since first described in the early 1900s. Studies have described the prevalence of this condition, the pathologic and electrophysiologic basis of this condition, the link between WPW Syndrome – paroxysmal supraventricular tachycardia – atrial fibrillation – and sudden cardiac death, and also the technique and outcomes of catheter ablation of WPW syndrome. In the present issue of Trends in Cardiovascular Medicine, Kim et al. [1] provide a thoughtful and comprehensively referenced review article which addressed the important topic of the long term risks associated both with WPW Syndrome and WPW pattern. Not only are the relevant clinical trials reviewed but also the recommendations by relevant guidelines are described. As they make clear in their article, the term WPW Syndrome refers to the presence of pre-excitation and symptoms associated with cardiac arrhythmias while WPW pattern reports to pre-excitation in the absence of symptoms, commonly referred to as an asymptomatic pre-excitation pattern. The studies reviewed in exquisite detail by the authors lead them to conclude that the risk of cardiac arrest in patients with WPW pattern is very low and the risk of death is even lower with rates ranging from 0.85 to 1.5 per 1000 patient years. They also remind readers that catheter ablation of accessory pathways is not without risk. And finally they conclude that noninvasive testing and watchful waiting are reasonable approaches to managing these asymptomatic patients. This review article is a welcome addition to the literature as we continue our quest to fully understand all aspects of WPW Syndrome and Pattern. I congratulate the authors for the considerable time and effort invested in writing this article. In the remaining space allotted to me I would like to share my personal perspective on this topic. I was fortunate to be on the faculty at the University of Michigan early in my career, in the pioneering days of radiofrequency catheter ablation of atrial fibrillation. It was in the late 1980s and early 1990s that Morady, Jackman, and Scheinman developed this procedure [2–5]. This was the time when patients with WPW syndrome filled our EP laboratories. It would be common to perform radiofrequency catheter ablation in two to three patients with WPW syndrome and/or WPW pattern each day of the week. My interest in WPW syndrome and WPW pattern was born at that time and has continued throughout my career. So what is my approach to WPW syndrome and WPW pattern? When evaluating a patient with WPW pattern on their ECG it is critical to first determine if they have symptoms consistent with a cardiac arrhythmia. If they do have symptoms, EP