Perioperative management of patients with preexcitation may become quite challenging, especially if there is no time for adequate preoperative investigation and clinical optimisation, as in emergencies, or even worse, in undiagnosed cases. It is possible that the poorly controlled or unknown underlying electrophysiological abnormality will become unmasked during anaesthesia and surgery, giving rise to potentially life-threatening arrhythmias.
In the literature, pre-excitation syndromes have been mainly approached from the view of the disease (i.e., presentation, diagnosis, treatment), while anaesthetic data are scarce.
This case report aims to focus on the perioperative management of patients with WPW.
Conclusion; Managing such cases provides an opportunity to revisit important considerations on Wolff-Parkinson-White syndrome Avoiding neuromuscular blockers may make a difference in avoiding arrhythmias when laryngeal mask airway / general anaesthesia is required in patients with Wolff-Parkinson-White syndrome. Sympathetic stimulation should be avoided as it may shorten the refractory period of AP and alleviate life-threatening arrhythmias.
Öhnell RF. Pre-excitation, cardiac abnormality, pathophysio- logical, patho-anatomical and clinical studies of excitatory spread phenomenon bearing upon the problem of the WPW (Wolff, Parkinson, and White) electrocardiogram and paroxysmal tachycardia. Acta Med Scand 1944; 152: 1-167
Keating L, Morris FP, Brady WJ. Electrocardiographic features of Wolff-Parkinson-White syndrome. Emerg Med J 2003; 20: 491-493. doi: 10.1136/emj.20.5.491
Al-Khatib SM, Pritchett ELC. Clinical features of Wolff- Parkinson-White syndrome. Am Heart J 1999; 138: 403-413. doi: 10.1016/S0002-8703(99)70140-7
Gollob MH, Green MS, Tang AS, Gollob T, Karibe A, Ali Hassan AS, et al. Identification of a gene responsible for familial Wolff- Parkinson-White syndrome. N Engl J Med 2001; 344: 1823- 1831. doi: 10.1056/NEJM200106143442403
Bengali R, Wellens HJ, Jiang Y. Perioperative management of the Wolff-Parkinson-White syndrome. J Cardiothorac Vasc Anesth 2014; 28: 1375-1386. doi: 10.1053/j.jvca.2014.02.003
Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, et al.; European Society of Cardiology Committee, NASPE-Heart Rhythm Society. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias – executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 2003; 42: 1493-1531. doi: 10.1016/j.jacc.2003.08.013
Chang RK, Wetzel GT, Shannon KM, Stevenson WG, Klitzner TS. Age- and anesthesia-related changes in accessory pathway conduction in children with Wolff-Parkinson-White syndrome. Am J Cardiol 1995; 76: 1074-1076. doi: 10.1016/S0002- 9149(99)80303-8
Lustik SJ, Wojtczak J, Chhibber AK. Wolff-Parkinson-White syndrome simulating inferior myocardial infarction in a cocaine abuser for urgent dilation and evacuation of the uterus. Anesth Analg 1999; 89: 609-612. doi: 10.1213/00000539-199909000- 00012
Le Manach Y, Charbucinska K, Godet G. Accessory myocardial pathway mimicking an inferior myocardial infarction after major vascular surgery. Eur J Anaesthesiol 2006; 23: 527-529. doi: 10.1017/S0265021506210755
Garg R, Sinha R, Nishad P. Patient with Wolff-Parkinson-White syndrome with intermittent pre-excitation under subarachnoid block for urological surgery. Indian J Anaesth 2011; 55: 167- 170. doi: 10.4103/0019-5049.79899
Irish CL, Murkin JM, Guiraudon GM. Anaesthetic management for surgical cryoablation of accessory conducting pathways: a review and report of 181 cases. Can J Anaesth 1988; 35: 634- 640. doi: 10.1007/BF03020354
Staikou C, Chondrogiannis K, Mani A. Perioperative manage- ment of hereditary arrhythmogenic syndromes. Br J Anaesth 2012; 108: 730-744 (doi: 10.1093/bja/aes105), and supplemental material (Table S1: Effects of commonly used anaesthetic drugs on cardiac electrophysiology)
Sharpe MD, Dobkowski WB, Murkin JM, Klein G, Yee R. Propofol has no direct effect on sinoatrial node function or on normal atrioventricular and accessory pathway conduction in Wolff-Parkinson-White syndrome during alfentanil/midazolam anesthesia. Anesthesiology 1995; 82: 888-895. doi: 10.1097/ 00000542-199504000-00011
Hino H, Oda Y, Yoshida Y, Suzuki T, Shimada M, Nishikawa K. Electrophysiological effects of desflurane in children with Wolff- Parkinson-White syndrome: a randomized crossover study. Acta Anaesthesiol Scand 2018; 62: 159-166. doi: 10.1111/aas.13023
Dobkowski WB, Murkin JM, Sharpe MD, Molotiu N, Guiraudon G, Yee R. The effect of enflurane (1 MAC) on the normal AV conduction system and accessory pathways. Anesth Analg 1991; 72: S50
Sharpe MD, Cuillerier DJ, Lee JK, Basta M, Krahn AD, Klein GJ, et al. Sevoflurane has no effect on sinoatrial node function or on normal atrioventricular and accessory pathway conduction in Wolff-Parkinson-White syndrome during alfentanil/ midazolam anesthesia. Anesthesiology 1999; 90: 60-65. doi: 10.1097/00000542-199901000-00010
Gómez-Arnau J, Márquez-Montes J, Avello F. Fentanyl and droperidol effects on the refractoriness of the accessory pathway in the Wolff-Parkinson-White syndrome. Anesthesiology 1983; 58: 307-313. doi: 10.1097/00000542-198304000-00002
Sharpe MD, Dobkowski WB, Murkin JM, Klein G, Guiraudon G, Yee R. Alfentanil-midazolam anaesthesia has no electrophysio- logical effects upon the normal conduction system or accessory pathways in patients with Wolff-Parkinson-White syndrome. Can J Anaesth 1992; 39: 816-821. doi: 10.1007/BF03008294
Wellens HJJ, Brugada P, Roy D, Weiss J, Bär FW. Effect of isoproterenol on the anterograde refractory period of the accessory pathway in patients with the Wolff-Parkinson-White syndrome. Am J Cardiol 1982; 50: 180-184. doi: 10.1016/0002-9149(82)90026-1
Naço M, Çeliku E, Llukaçaj A, Shehaj J, Kameniku R. Toxic adenoma of the thyroid gland and Wolff-Parkinson-White syndrome. Hippokratia 2009; 13: 116-118
Richmond MN, Conroy PT. Anesthetic management of a neonate born prematurely with Wolff Parkinson White syndrome. Anesth Analg 1988; 67: 477-478 Anaesthesia for pre-excitation syndromes 145
Schmitz JP, Holmgreen WC. Outpatient anesthetic management of a patient with Wolff-Parkinson-White syndrome. J Oral Maxillofac Surg 1997; 55: 175-179. doi: 10.1016/S0278- 2391(97)90239-1
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.