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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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  • 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.


  • 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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Rosen, Peter, et al., editors. "Wolff–parkinson–white (Wpw) Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307700/all/Wolff_parkinson_white__Wpw__Syndrome.
Wolff–parkinson–white (Wpw) Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307700/all/Wolff_parkinson_white__Wpw__Syndrome. Accessed April 22, 2019.
Wolff–parkinson–white (Wpw) Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307700/all/Wolff_parkinson_white__Wpw__Syndrome
Wolff–parkinson–white (Wpw) Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 22]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307700/all/Wolff_parkinson_white__Wpw__Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Wolff–parkinson–white (Wpw) Syndrome ID - 307700 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, 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 -