What are the indications for referring a patient with WPW to a cardiologist for further evaluation or management?

Indications for referring a patient with Wolff-Parkinson-White (WPW) syndrome to a cardiologist include:

• Presence of WPW syndrome or pre-excitation pattern on ECG, regardless of symptoms, warrants referral for further evaluation and management.
• Urgent referral is indicated if the patient has a history of syncope or near syncope, especially if palpitations are precipitated by exercise.
• Referral is also recommended if there is a family history of sudden cardiac death under the age of 40 years.
• Patients with WPW syndrome who have accompanying chest pain, lightheadedness, or symptoms suggestive of structural heart disease, heart failure, or hypertension should be referred routinely.
• Any resting ECG abnormalities other than second or third degree atrioventricular block, or a history of recurrent sustained tachyarrhythmia, atrial fibrillation, or flutter, also indicate referral.
• Patients with WPW syndrome who experience supraventricular tachycardia (SVT), whether terminated by vagal maneuvers or not, should be referred to cardiology.
• Urgent admission or referral is required if the patient has haemodynamic instability, ventricular tachycardia, or features suggestive of a serious underlying cardiac cause or complication.

These recommendations are based on expert opinion and UK clinical guidelines on palpitations and arrhythmias, which emphasize the importance of specialist cardiology assessment in WPW syndrome due to the risk of serious arrhythmias and sudden cardiac death ¹.