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Wolff-Parkinson-White Syndrome

Aka: Wolff-Parkinson-White Syndrome, Wolff-Parkinson-White, WPW Syndrome
  1. See Also
    1. Supraventricular Tachycardia
    2. Atrioventricular Nodal Reentry (AVNRT)
    3. Atrioventricular Reciprocating Tachycardia (AVRT)
    4. Atrial Tachycardia
    5. Unstable Tachycardia
    6. Sinus Tachycardia
    7. Atrial Fibrillation
    8. Unstable Tachycardia
    9. Narrow Complex Tachycardia
    10. Wide Complex Tachycardia
    11. Cardiopulmonary Resuscitation
    12. Supraventricular Tachycardia Management in the Child
    13. Supraventricular Tachycardia Management in the Adult
  2. Definition
    1. Arrhythmia associated with AV bypass tract
    2. Subtype of Atrioventricular Reciprocating Tachycardia (AVRT) distinguised by its delta wave
  3. Epidemiology
    1. Prevalence: 2 per 1000 general population
  4. Pathophysiology
    1. Atrioventricular bypass tract
      1. Circumvents normal PR Interval delay (up to 0.2 sec)
      2. Allows for ventricular pre-excitation
    2. Predisposes to Arrhythmia
      1. Reentrant Paroxysmal Supraventricular Tachycardia
      2. Paroxysmal Atrial Fibrillation
  5. Findings: EKG changes
    1. Precautions
      1. WPW EKG Findings may be variably present
      2. Classic findings are more prominent with Valsalva Maneuver (or other increased vagal tone)
    2. Narrow PR Interval
      1. Due to pre-excitation of ventricle
      2. Look closely for Delta wave when a narrow PR Interval is identified on EKG
    3. Delta wave
      1. Slurred upstroke of QRS (hockey stick appearance)
      2. Wide QRS related to delta wave (to extent that PR Interval is narrowed)
    4. Other changes
      1. ST and T Wave deflections that are discordant (opposite) to the QRS deflection
    5. Images
      1. ekg20214a_1_svtToWpw.jpg

  6. Differential Diagnosis
    1. Right or Left Bundle Branch Block (wide complex)
    2. Myocardial Infarction (Q Wave when QRS negative)
  7. Precautions
    1. Agents to avoid in WPW (may accelerate Arrhythmia via accessory path)
      1. Adenosine
      2. Beta Blockers (e.g. Metoprolol)
      3. Calcium Channel Blockers (e.g. Verapamil, Diltiazem)
      4. Digoxin (Lanoxin)
    2. Have a high index of suspicion in young patients with Syncope
      1. WPW may be present despite an absence of Short PR Interval and a Delta Wave
    3. Sinus Tachycardia can still occur with all of the typical reasons seen in patients without WPW
      1. Consider Dehydration, infection, Pulmonary Embolism in the differential in a patient with WPW and Tachycardia
  8. Management
    1. See Unstable Tachycardia
    2. Safe interventions in WPW
      1. Amiodarone
      2. Procainamide
      3. Synchronized Cardioversion
  9. Complications
    1. Atrioventricular Re-Entry Tachycardia (AVRT)
      1. Rates are typically very high (200-300 bpm)
    2. Atrial Fibrillation (20% of WPW patients)
    3. Atrial Flutter (7% of WPW patients)
    4. Ventricular Tachycardia or Ventricular Fibrillation
    5. Sudden Cardiac Death
  10. References
    1. Braude, Swadron and Orman et. al. in Majoewsky (2012) EM:RAP 12(7): 1-2
    2. Goldberger (1999) Clinical Electrocardiography, p 127-8
    3. Grauer (2001) 12 Lead EKG, p. 27
    4. Joshi and Dermark (2016) Crit Dec Emerg Med 30(8):3-12

Wolff-Parkinson-White Syndrome (C0043202)

Definition (MSH) 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.
Definition (MSHCZE) Typ arytmie s předčasnou aktivací srdeční komory cestou akcesorního Kentova svazku. Onemocnění je vrozené a projevuje se někdy paroxysmy či fibrilací síní, které mohou narušit funkci srdce. Patří k typu arytmie zvanému preexcitace. Na EKG se projevuje zkrácením intervalu PQ, resp. PR (předčasná aktivace komor), popř. i vlnou delta (předčasné šíření vzruchu v komorách), která rozšiřuje komorový komplex. (cit.: Velký lékařský slovník on-line, 2013, http://lekarske.slovniky.cz/ )
Definition (NCI) A cardiac conduction disorder characterized by an electrocardiographic finding of ventricular pre-excitation, which is a short PR interval and a long QRS interval with a delta wave. Most individuals are asymptomatic; however they can experience periods of palpitations, shortness of breath or syncope during tachycardic episodes.
Definition (NCI_CTCAE) A disorder characterized by the presence of an accessory conductive pathway between the atria and the ventricles that causes premature ventricular activation.
Definition (NCI_CDISC) An electrocardiographic finding of ventricular pre-excitation. The syndrome is characterized by a short PR interval and a long QRS interval with a delta wave.
Definition (CSP) association of paroxysmal tachycaria or atrial fibrillation and pre-excitation characterized by a short PR interval and a long QRS interval with a delta wave.
Concepts Disease or Syndrome (T047)
MSH D014927
ICD10 I45.6
SnomedCT 74390002, 251115003, 155360000, 266304003
English Syndrome, Wolf-Parkinson-White, Syndrome, WPW, Wolf Parkinson White Syndrome, Wolf-Parkinson-White Syndrome, WPW Syndrome, Syndrome, Wolff-Parkinson-White, Wolff Parkinson White Syndrome, Wolff-Parkinson-White syndrome, WPW - syndrome, Wolff-Parkinson-White Syndrome, WOLFF-PARKINSON-WHITE SYNDROME, WPW SYNDROME, WPW - Wolff-Park-White pattern, Wolff Parkinson White syndrome (diagnosis), WPW syndrome, Wolff-Parkinson-White Syndrome [Disease/Finding], False Bundle-Branch Block Syndrome, Auriculoventricular Accessory Pathway Syndrome, Anomalous Ventricular Excitation Syndrome, parkinson syndrome white wolff, wolf white parkinson syndrome, parkinsons syndrome white wolf, parkinsons syndrome white wolff, syndrome wolff parkinsons white, syndrome wpw, wpws, parkinson syndrome whites wolf, parkinson wolf white syndrome, wolf parkinson white syndrome, wolf-parkinson-white syndrome, wolff parkinson syndrome white, wolff-parkinson-white syndrome, parkinson syndrome whites wolfs, parkinsons syndrome white wolfs, syndrome wolff-parkinson-white, syndrome wolf parkinsons white, wpw, wpw syndrome, Wolff-Parkinson-White ventricular preexcitation, Wolff Parkinson White syndrome, Wolf-Parkinson-White syndrome, Wolff-Parkinson-White arrhythmia, Ventricular Pre-Excitation with Arrhythmia, Wolff-Parkinson-White pattern (finding), Wolff-Park-White syndr., Wolff - Parkinson - White syndrome, WPW, Wolff-Parkinson-White pattern, WPW - Wolff-Parkinson-White pattern, WPW - Wolff-Parkinson-White syndrome, Ventricular pre-excitation with arrhythmia, Wolff-Parkinson-White pattern (disorder), wolff-Parkinson-White syndrome, Ventricular pre-excitation with arrhythmia, NOS, Wolff-Parkinson-White syndrome congenital, wolff parkinson white syndrome
Italian Sindrome di Wolff-Parkinson-White congenita, Sindrome di WPW, Sindrome di Wolff-Parkinson-White
Dutch syndroom van WPW, syndroom van Wolff-Parkinson-White, syndroom van Wolff-Parkinson-White, congenitaal, Syndroom, Wolff-Parkinson-White-, WPW-syndroom, Wolff-Parkinson-White-syndroom
Japanese 先天性ウォルフ・パーキンソン・ホワイト症候群, ウォルフ・パーキンソン・ホワイト症候群, ＷＰＷ症候群, ｳｫﾙﾌﾊﾟｰｷﾝｿﾝﾎﾜｲﾄｼｮｳｺｳｸﾞﾝ, ｾﾝﾃﾝｾｲｳｫﾙﾌﾊﾟｰｷﾝｿﾝﾎﾜｲﾄｼｮｳｺｳｸﾞﾝ, WPWｼｮｳｺｳｸﾞﾝ, ウルフ･パーキンソン･ホワイト症候群, ウォルフ･パーキンソン･ホワイト症候群, Wolff-Parkinson-White症候群, WPW症候群, ウォルフ-パーキンソン-ホワイト症候群, 副伝導路症候群, 心室早期興奮症候群, ウルフ-パーキンソン-ホワイト症候群
Swedish Wolff-Parkinson-Whites syndrom
Czech Wolffův-Parkinsonův-Whiteův syndrom, Vrozený Wolff-Parkinson-Whiteův syndrom, Wolf-Parkinson-Whiteův syndrom, syndrom Wolffův-Parkinsonův-Whiteův, WPW syndrom
Finnish Wolff-Parkinson-Whiten oireyhtymä
Russian VOL'FA-PARKINSONA-UAITA SINDROM, ВОЛЬФА-ПАРКИНСОНА-УАЙТА СИНДРОМ
Polish Zespół WPW, Zespół Wolffa-Parkinsona-White'a
Hungarian WPW syndroma, Wolff-Parkinson-White syndroma, Veleszületett Wolff-Parkinson-White syndroma
Spanish síndrome de Wolff - Parkinson - White (trastorno), patrón de Wolff-Parkinson-White, síndrome de Wolff - Parkinson - White, patrón de Wolff-Parkinson-White (trastorno), síndrome de Wolff-Parkinson-White (trastorno), síndrome de Wolff-Parkinson-White, patrón Wolff-Parkinson-White (hallazgo), patrón Wolff-Parkinson-White, preexcitación ventricular con arritmia, Síndrome congénito de Wolff-Parkinson-White, Síndrome de Wolff-Parkinson-White, Síndrome WPW
Norwegian Wolff-Parkinson-Whites syndrom, Aksessoriske ledningsbaner av WPW-type
Portuguese Síndroma de Wolff-Parkinson-White, Síndrome de Wolff-Parkinson-White congénito, Síndrome de Wolff-Parkinson-White, Síndrome WPW
French Syndrome de Wolff-Parkinson-White congénital, Syndrome de Wolff-Parkinson-White, Syndrome WPW, Syndrome de WPW
German Wolff-Parkinson-White Syndrom kongenital, WPW-Syndrom, Wolff-Parkinson-White-Syndrom
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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