Aliases:
WPW
WPW Syndrome
Wolf Parkinson White Syndrome

Topic aliases are alternate phrasings for a particular topic.


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A form of ventricular pre-excitation characterized by a short PR interval and a long QRS interval with a delta wave. In this syndrome, atrial impulses are abnormally conducted to the HEART VENTRICLES via an ACCESSORY CONDUCTING PATHWAY that is located between the wall of the right or left atria and the ventricles, also known as a BUNDLE OF KENT. The inherited form can be caused by mutation of PRKAG2 gene encoding a gamma-2 regulatory subunit of AMP-activated protein kinase.
www.nlm.nih.gov/cgi/mesh/...

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Type A (most common): Predominantly positive in V1. Accessory pathway is left sided.
Type B: (example above) Predominantly negative in V1. Accessory pathway is right sided. refl.in/6q.

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ECG changes
1. Delta waves (although some patients may have a "concealed pathway" in which delta waves may only be intermittent).
2. Short PR interval. (Normal ~ 0.13-0.2s or 3-5 small squares)
3. Widened QRS (>0.12s or 3 small squares). Changes are due to early ventricular depolarisation via accessory pathway bypassing the AV node refl.in/5w

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Example of Type A WPW

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Example of Type A WPW again

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Atrial fibrillation and Atrial flutter accounts for 20% of tachyarrhythmias refl.in/6

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If the patient develops atrial fibrillation or atrial flutter they are at risk of unregulated conduction through their accessory pathway leading to VT & VF. refl.in/6

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Most common arrhythmia is narrow complex, AV nodal re-entrant tachycardia ( AVNRT ). refl.in/6

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WPW patients with a history of tachyarrhythmias facing surgery with a high risk of post-op atrial fibrillation/flutter (cardiac surgery), consider AP ablation before elective surgery refl.in/6

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Sympathetic stimulation increases risk of arrhythmia. Minimise stress & pain, & avoid ketamine. refl.in/6

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ACLS 2010 guidelines suggest Amiodarone or Flecainide or Procainamide for pharmacological reversion of Atrial fibrillation/Atrial flutter with WPW refl.in/6y from refl.in/6x

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Review in Canadian Journal of Emergency Medicine questions safety of Amiodarone in AF/Afib in WPW refl.in/6w
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If atrial fibrillation or atrial flutter, at risk of ventricular fibrillation from AV nodal blockers (Digoxin, Calcium channel, beta blockers, and adenosine) refl.in/77

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Adenosine an option for pharmacological Rx for SVT in patient with WPW (although ensure its not AF/Afib as they may degenerate into VF/VT) & plan for urgent defibrillation refl.in/2e

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If in doubt about the regularity of the rhythm, it is safer to err on the side of treating for AFib in the context of Wolff-Parkinson-White syndrome with direct cardioversion. refl.in/2e

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