THE WOLFF-PARKINSON-WHITE SYNDROME IN INFANTS AND CHILDREN

Abstract

It is the belief of the authors that the Wolff-Parkinson-White syndrome, although frequently misinterpreted, is not an uncommon finding in infants and children. This electrocardiographic pattern occurred approximately once among every 200 children (0.5%) referred for cardiac evaluation. Twenty-eight infants and children with the Wolff-Parkinson-White syndrome, 19 (68%) of whom were males, were arbitrarily classified into five general groups: 1) "traditional—9 cases; and those associated with 2) congenital heart disease–13 cases; 3) rheumatic heart disease–1 case; 4) familial cardiomegaiy–2 cases; and 5) disease of the central nervous system–5 cases. Only two patients were placed in more than one category. The small number in the "traditional" group (9 of 28 cases) is striking. About half of the cases studied had associated congenital heart disease, particularly Ebstein's anomaly of the tricuspid valve. A review of reported cases with the Wolff-Parkinson-White syndrome and congenital heart disease appears to show that this syndrome may be associated with many congenital malformations of the heart, but particularly with dextrocardia and anomalies of the tricuspid valve (Ebstein's malformation and tricuspid atresia). The association of the Wolff-Parkinson-White syndrome with diseases of the central nervous system and with congenital anomalies in other areas of the body is noted. Fourteen of the patients (50%) had episodes of tachycardia, and paroxysms of tachycardia were suspected in two others. Digitalis preparations have proved to be efficacious in terminating the bouts of tachycardia in children. The prognosis in those individuals without any other congenital anomaly is usually good. On the basis of this study, the authors consider that every child with this electrocardiographic pattern should be investigated for additional abnormalities.