Wolff-Parkinson-White Syndrome in a Young Man

A 29-year-old man presents with a recent episode of light-headedness of sudden onset. Although he denies associated loss of consciousness, witnesses report that he was briefly unresponsive to verbal stimuli. He also denies chest pain, dyspnea, palpitations, and diaphoresis; he is currently asymptomatic. HISTORY The patient had a similar episode 2 years earlier for which he did not seek medical attention. Otherwise, his medical history is unremarkable. He denies alcohol and illicit drug use, and he has no family history of cardiac disease or sudden death.PHYSICAL EXAMINATION His vital signs are normal. Heart rate is regular and rhythm is normal; no murmurs are audible. Results of the rest of the examination are normal.LABORATORY AND IMAGING RESULTS Results of a complete blood cell count and comprehensive metabolic profile are all normal, as is a chest radiograph. ECG reveals a Wolff-Parkinson-White (WPW) pattern, with characteristic short PR interval and preexcitation delta wave. Which of the following statements is true? A. The patient should be given digoxin if tachycardia develops. B. The arrhythmia most likely to have caused his symptoms is ventricular tachycardia. C. He should be discharged and told to call your office only if the symptoms recur. D. He should be referred for an electrophysiology study.CORRECT ANSWER: D WPW syndrome is the most common type of ventricular preexcitation syndrome. In 1930, Wolff, Parkinson, and White were the first to describe an ECG pattern with the following 2 major features: