Wolff–Parkinson–White syndrome

Wolff-Parkinson-White (WPW) Syndrome is a combination of the presence of a congenital accessory pathway and episodes of tachyarrhythmia.

WPW syndrome is characterized by a double stimulation of the ventricles. A premature conduction wave via accessory pathways (preexcitation) stimulates the portions of the ventricles nearest the atrium; then the ventricles depolarize as a result of the conduction wave which proceeds normally through the atrioventricular (AV) node.

The clinical significance of this syndrome depends on the appearance of (supraventricular) reentry tachycardias.

History

1915 – Frank Norman Wilson (1890–1952) first to describe the condition [Wilson FN, 1915]

1921 – Alfred M. Wedd (1887–1967) next to describe the syndrome [Wedd AM, 1921]

1928 – On April 2 a young man was referred to Paul Dudley White because his physician was perplexed by the occurrence of paroxysmal atrial fibrillation in a healthy individual. White was preparing for visits to overseas medical centers and took the ECG’s with him.

• Vienna: the tracing was deemed to represent nothing more unusual than bundle-branch block and atrioventricular (AV) nodal rhythm
• London: Parkinson was interested and found a further seven cases to add to the four from Boston.

1930 – Wolff L, Parkinson J, and White PD publish the eleven cases as definitive description of the syndrome – ‘Bundle Branch Block with Short P-R Interval in Healthy Young People Prone to Paroxysmal Tachycardia.’

Wolff first met Parkinson many years later at the Second World Congress of Cardiology in 1954

Associated Persons

• Louis Wolff (1898-1972)
• Sir John Parkinson (1885-1976)
• Paul Dudley White (1886-1973)

LITFL Links

• Pre-excitation Syndromes – LITFL ECG Library

References

• Kent AFS. Researches on the Structure and Function of the Mammalian Heart. J Physiol. 1893 May; 14(4-5): i2–254. [PMC1514401]
• Kent AFS. A conducting path between the right auricle and the external wall of the right ventricle in the heart of the mammal. J Physiol. 1914;48:57. [PMC2299573]
  
• His W. Die Thatigkeit des embryonalen Herzens und deren Bedeutung fur die Lehre von der Herzbewegung beim Erwachsenen. Med Klinik in Leipzig. 1893;I:14.
• Wilson FN. A case in which the vagus influenced the form of the ventricular complex of the electrocardiogram. 1915. Ann Noninvasive Electrocardiol. 2002 Apr;7(2):153-73. [PMID 12085794]
• Wedd, A.M. Paroxysmal tachycardia with reference to nomotopic tachycardia and role of extrinsic cardiac nerves. Arch Intern Med. 1921;27:571–590. [JAMA]
• Wolff L, Parkinson J, White PD. Bundle-branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia. 1930. Ann Noninvasive Electrocardiol. 2006 Oct;11(4):340-53. [PMID 17040283]
• Wellens HJ, Schuilenberg RM, Durrer D. Electrical stimulation of the heart in patients with Wolff-Parkinson-White syndrome, type A. Circulation. 1971 Jan;43(1):99-114. [PMID 5540856]
• Moss, AJ. History of Wolff-Parkinson-White Syndrome: Introductory Note to a Classic Article by Louis Wolff, M.D., John Parkinson, M.D., and Paul D. White, M.D. Ann Noninvasive Electrocardiol. 2006 Oct;11(4):338-9. [PMID 17040282]
• Scheinman MM. The History of the Wolff–Parkinson–White Syndrome. Rambam Maimonides Med J. 2012 Jul; 3(3): e0019. [PMC3678820]
• Gaskell WH. On the Innervation of the Heart, with especial reference to the Heart of the Tortoise. J Physiol. 1883 Aug; 4(2-3): [43]-127, 230-1-230-14. [PMC1484944]