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

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