Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 7 2021

Wolff-Parkinson-White (WPW) Syndrome

  • Snapshot
    • A 17-year-old girl presents to the emergency room with lightheadedness and palpitation. Her pulse is 250/min and she is hemodynamically stable. An electrocardiogram shows an antidromic atrioventricular reentrant tachycardia. She is given procainamide with a resolution of the arrhythmia. Now in sinus rhythm, she is found to have a widened QRS, delta wave, and shortened PR interval on the electrocardiogram.
  • Introduction
    • Clinical definition
      • a ventricular pre-excitation syndrome resulting in an aberrant conduction tract that bypasses the atrioventricular (AV) node
    • Associated conditions
      • Ebstein anomaly
      • hypertrophic cardiomyopathy
  • Epidemiology
    • Risk factors
      • family history
  • Etiology
    • Can be familial
    • Pathogenesis
      • ventricular pre-excitation results from an aberrant conduction tract from the atria to the ventricle, known as the bundle of Kent
        • this fast accessory tract bypasses the slowest-conducting AV node
        • ventricles then depolarize earlier than normal
        • this causes the classic delta wave and widened QRS
      • administration of calcium channel blockers or digoxin will worsen a supraventricular tachycardia (SVT) caused by WPW syndrome
        • calcium channel blockers and digoxin block conduction in the AV node and will force more conduction down the aberrant tract, worsening WPW syndrome
  • Presentation
    • Symptoms
      • can be asymptomatic
      • if symptomatic, patients will present with an arrhythmia
        • palpitations
        • lightheadedness
        • syncope
        • dizziness
        • chest pain
    • Physical exam
      • tachycardia
  • Studies
    • Electrocardiogram (ECG)
      • delta wave
      • short PR interval
      • widened QRS complex
      • may have supraventricular tachycardia if symptomatic
    • Making the diagnosis
      • based on clinical presentation and ECG
  • Differential
    • Myocardial infarction
      • distinguishing factor
        • ST elevation on ECG
    • Bundle branch block
      • distinguishing factor
        • widened and abnormal terminal portion of QRS portion on ECG
  • Treatment
    • Management approach
      • drugs that delay AV node conduction is typically contraindicated in these patients, unless patients have confirmed orthodromic AVRT
    • Medical
      • procainamide
        • indications
          • for patients who are hemodynamically stable
          • for patients with antidromic AVRT (wide QRS complexes) or atrial fibrillation due to WPW syndrome
      • adenosine or calcium channel blocker
        • indication
          • for patients with orthodromic AVRT (narrow QRS complexes)
    • Non-operative
      • electrical cardioversion
        • indication
          • for all patients who are hemodynamically unstable due to arrhythmia
      • radiofrequency catheter ablation
        • indication
          • long-term definitive therapy for patients with WPW syndrome
  • Complications
    • Sudden cardiac death
  • Prognosis
    • Can present with the following arrhythmias
      • atrioventricular reentrant tachycardia (AVRT)
        • most commonly as orthodromic AVRT
          • narrow QRS complexes (< 120 ms)
        • less commonly as (5%) antidromic AVRT
          • wide QRS complexes
      • atrial fibrillation
      • atrial flutter
      • ventricular tachycardia
      • ventricular fibrillation and sudden death
1 of 0
1 of 5
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options