Author(s): STOIAN, I.M., IONESCU, A., STOIAN, I., GEORGESCU, M., DRAGOMIR, A., Institution: STOIAN I. IOANA MARINA - MEDIC PRIMAR CARDIOLOGIE, Country: ROMANIA, Abstract-ID: 639

INTRODUCTION:
Introduction:The Wolff-Parkinson-White (WPW) Syndrome, a dynamic heart condition present at birth, often asymptomatic, consists of an accessory pathway (AP) for signals to travel between the heart’s upper and lower chambers, by-passing the normal way and causing sometimes a fast heart rhythm (150-220/min), regular (supraventricular tachycardia,SVT) or irregular (atrial fibrillation,AF) responsible for severe ventricular arrhythmias and sudden cardiac death (SCD). Athletic activity, through exercise related adrenergic activation, accentuates the risk of SVT/AF and SCD during exercise (1,2). Asymtomatic or no, WPW may be diagnosed in otherwise healty athletes (ath)and treated accordingly.
Aim:A retrospective study:2018-2023. In asymptomatic ath the potentially lethal arrhythmic events associated to WPW may be the first ‘presentation’. To recognize the incidence of WPW in the Pre-Participation Cardiac (PPC) screening and in yearly follow-up.To assess the medical indications including electrophysiological study (EPS) indications according to the condition’s severity and SCD risks.

METHODS:
Method:1523 ath; 16-32 yo; male 65%. Sports: football, rowing, athletics. Initial PPC and yearly follow-up:all ath. PPC Protocol: Focused history (palpitations, pre-syncope /syncope).Clinical exam.Resting electrocardiography (ECG)-WPW and high risk SVT/AF criteria (3).EPS and specific AP- EP criteria for SCD high risk(4) in all WPW ath.
RESULTS:
Results: PPC: 1523 ath; 24 (1.57%) WPW ath. Study Group (WPW-EPS):24 ath age 16-32;14 M; H 174+/-3 cm; W 75+/-3 kg. Asymptomatic: 14 (58.3%) ath: EPS-WPW high risk, 9 (64%). Symptomatic: 10 (41.6 %) ath: EPS-WPW high risk, 10 (100%). Catheter Ablation (AP): 23 (95.8%); one postponed.
CONCLUSION:
Discussion&Conclusions: WPW was diagnosed in 1.57% ath. As a very dynamic condition, WPW is diagnosed sometimes solely by repeated ECGs (2, 8.3% ath). WPW with high risk of SCD while intense exercise is a real threat to ath even in those without symptoms. In the Study Group, the real free-symptoms were in 14 (58.3% ) ath and 10 (41.6% ) had few palpitations before the WPW-ECG is diagnosed. Severe arrhythmias/ SCD risk stratification by EPS as a mandatory procedure was indicated in all ath, followed by AP ablation when necessary.
WPW diagnosis must rely on the ECG in PPC and follow-up.EPS is mandatory.The life threatening AP catheter ablation is the only way of treatment.
References.
1.Jose A Joglar et al.2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis Management of Atrial Fibrillation.J Am Col Card 2024;Vol 83 No1:109-279.
2.Melhotra A et al. Outcomes of cardiac screening in adolescent soccer players.New Engl J Med.2018;379 (6):524-534.
3.Lisa W.M Leung, Mark M Gallagher.Review paper on WPW and athletes: Let sleeping dogs lie? Clin Cardiol 2020;43:897-905.
4.Brugada J et al.2019 ESC Guidelines for the Management of Patients With Supraventricular Tachycardia.Eur Heart J.2020;41:655-720.