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    Wolff–parkinson–white (Wpw) Syndrome

    Wolff–parkinson–white (Wpw) Syndrome is a topic covered in the 5-Minute Emergency Consult.

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    Basics

    Description

    • Syndrome resulting from the presence of an abnormal (accessory) pathway that bypasses the AV node (Kent bundles) between the atria and ventricles
    • Wolff–Parkinson–White (WPW) pattern on the ECG is defined by a short PR interval and a Δ-wave reflecting early conduction (pre-excitation):
      • Accessory pathways occur in 0.1–0.3% of the population.
    • WPW syndrome requires ECG evidence of the accessory pathway and related tachycardia.
    • Accessory pathways:
      • Small bands of tissue that failed to separate during development:
        • Left lateral (free wall) accessory pathway: Most common
        • The posteroseptal region of the AV groove: 2nd most common location
        • Right free wall
        • Anteroseptal
    • Conduction in WPW may be antegrade, retrograde, or both.
    • Orthodromic re-entrant tachycardia is the most common (70%):
      • Impulse travels antegrade from the atria down the AV node to the ventricle and then retrograde up the accessory pathway.
      • This re-entrant tachycardia is a narrow complex rhythm unless a bundle branch block or intraventricular conduction delay is present.
    • Antidromic is less common (30%):
      • Impulse travels antegrade down the accessory pathway and retrograde through the AV node resulting in a wide quasi-random signal (QRS) complex.
    • Sudden death occurs in 1 per 1,000 patient-years in persons with known ventricular pre-excitation.

    Etiology

    • Idiopathic:
      • Unknown mechanism in most cases, with familial predisposition
    • Rarely inherited as an autosomal dominant trait
    • Associated in rare cases with a familial hypertrophic cardiomyopathy

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    Citation

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    TY - ELEC T1 - Wolff–parkinson–white (Wpw) Syndrome ID - 307700 ED - Barkin,Adam Z, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Shayne,Philip, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307700/all/Wolff–parkinson–white__Wpw__Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -