Wolff-Parkinson-White (WPW) Syndrome

Had practical lesson in Arrhythmia-ICU today. Dr. Valek kicked off the session with some ECGs for us to interpret. I am quite satisfied with myself for not knowing 'only' 4 of them, LOL. I must really thank Dr. Thaller :)

I was quite amazed by the multiple ECGs of a same patient with WPW syndrome.

Something I read about WPW syndrome but did not realised its importance:

-if there is short PR interval, wide ORS with delta wave but patient doesn't have paroxysmal tachycardia, the patient has only preexcitation and this is called WPW pattern.

-if there is WPW pattern(as mentioned above) and patient has history of paroxysmal tachycardia, it is then only called WPW syndrome

-the most common arrhythmia in WPW syndrome is Atrioventricular Reentrant Tachycardia(AVRT)

-there are two forms of AVRT: orhtodromic AVRT and antidromic AVRT (depending on how the impulse goes in the reentrant circuit)

-Vagal maneuvre can be used to terminate AVRT as it transiently blocks AVN

-Atrial Fibrillation and Atrial Flutter can occur too

-Rx: antiarrhythmics

-Do not use calcium channel blocker, digoxin or beta blocker!!

-iv procainamide for AF and AFL in patient with bypass tract. Electrical cardioversion can be considered

-radiofrequency cathether ablation (95% success rate)

*Study Lown-Ganong-Levine Syndrome too!