Wolf-Parkinson-White (WPW) Syndrome

Wolf-Parkinson-White (WPW) Syndrome

David Ray Velez, MD

A Pre-Excitation Syndrome Due to an Accessory AV Pathway Through the Bundle of Kent

EKG Pattern

  • Pre-Excitation “Delta Waves” (Slurring Slow Risk of the Initial QRS Complex)
  • Short PR Interval (< 120 ms)
  • Prolonged QRS Complex

Wolf-Parkinson-White (WPW) Syndrome

Pathophysiology

  • A Pre-Excitation Syndrome Due to an Accessory AV Pathway Through the Bundle of Kent
  • Atrial Impulse Passes Through Both the AV Node and the Accessory Pathway
  • The Accessory Pathway Conducts the Signal Faster but the Subsequent Ventricular Activation is Slower Since it is Not Through the Conducting System (Seen as a Delta Wave)
  • May Cause Recurrent SVT

Treatment

  • Unstable: Synchronized Cardioversion
  • Stable: Procainamide
    • Dosing: 15 mg/kg Total Dose at 20-50 mg/min
    • Other Options: Flecainide, Ibutilide
    • Avoid Drugs that Block the AV Node (β-Blockers, Calcium Channel Blockers, Digoxin) – These Can Cause Conversion to Ventricular Tachycardia or Ventricular Fibrillation
    • Consider Catheter Ablation in the Chronic Management
  • *See Antiarrhythmic Pharmacology