Wolff-Parkinson-White (WPW) syndrome is a congenital heart disease that involves an accessory electrical pathway between the atria and ventricles, and in children, it may produce episodes of rapid heart rhythm, most commonly atrioventricular reentrant tachycardia and less commonly atrial fibrillation that may conduct very rapidly to the ventricles and very rarely precipitate ventricular fibrillation. WPW syndrome is diagnosed by the WPW pattern on the electrocardiogram in approximately 0.15% to 0.25% of the general population, and a significant proportion of those children will have symptomatic episodes during childhood or adolescence, while sudden cardiac death is rare in WPW syndrome, but children may have a relatively higher risk compared with adults, especially if they have very rapid-conducting or multiple accessory pathways. In the past, pediatric management was generally pharmacologic therapy and a watchful waiting approach in asymptomatic children given the perceived procedural risks, however, the situation has changed with 3D mapping, improved catheters, and safer energy delivery, and invasive therapy is now much safer and more effective. Consequently, in the past 15 years, catheter ablation has emerged as a first-line therapy and often curative procedure in children and has shifted the treatment paradigm toward earlier definitive therapy. Despite this, antiarrhythmic drugs remain important in the acute management of arrhythmias and as a bridge therapy in selected patients, particularly infants and smaller children who may not be suitable candidates for ablation at present, and surgical ablation, once the mainstay of definitive therapy, is now rarely required but still has a place in selected cases. Therefore, ongoing familiarity with the use of these therapeutic modalities and when to select one therapy over another will help to optimize outcomes and reduce long-term arrhythmic risk in children with WPW.

Wolff–Parkinson–White syndrome, pediatric arrhythmia, supraventricular tachycardia, catheter ablation.

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