Wolff-Parkinson-White syndrome | Lecture Note - Edubirdie

University:
The University Of Western Ontario
Course:
Pathology 3500B | Human Pathology
Academic year:

2023
Views:

61

Pages:

3
Author:

Kyuwon J.

WPW ● Pre-excitation syndrome ○ Accessory conduction pathway ■ Bundle of Kent ○ Electrical signal bypass AV nodes ⇒ early ventricular activation Path ● Normal conduction ○ SA ⇒ AV ⇒His-Purkinje sys ⇒ ventricles ● In WPW ○ Impulse travel ■ AV nodes - normal path ■ Accessory pathway - faster with no delay ● Pre-excitation of ventricles ● Re-entry circuits ⇒ tachyarrhythmias WPW types ● Atrioventricular Re-entrant Tachycardia ■ Common arrhythmia in WPW ○ Orthodromic AVRT ■ Impulse ● Down AV node ● Up accessory path ■ ECG ● Narrow QRS ○ Antidromic AVRT ■ Impulse ● Down accessory pathway ● Up AV node ■ ECG ● Wide QRS ● Atrial Fibrillation with WPW ○ Dangerous ○ Rapid conduction through accessory pathway ○ Could lead to ventricular fibrillation ■ Sudden death ECG findings ● Classic triad ○ Short PR intervals ■ <120ms ○ Delta wave ■ Slurred upstroke of QRS ○ Wide QRS complex Cx ● Smx ○ Palpitation ○ Dizziness ○ Syncope ○ Discomfort on chest ● Severe case ○ Sudden cardiac arrest ■ Rare, but if it is seen, serious complications ● Could be asmx ○ Found initially on ECG Trigger ● Exercise ● Stress ● Caffeine ● Alcohol Dx ● Primarily dx by ECG findings ● Further evaluation is done through EP study Acute Mx ● Stable Tachycardia ○ Vagal maneuvers ○ Adenosine ■ Only in case of orthodromic AVRT ● Atrial Fibrillation w WPW ○ Critical ○ AV node blockers are contraindicated ■ Avoid ● Beta-blockers ● ● ■ Use ● ● Calcium channel blocker Digoxin Procainamide Electrical cardiversion ○ Once it is unstable

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