; Wolf-Parkinson White Syndrome
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Wolf-Parkinson White Syndrome

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									Wolf-Parkinson White Syndrome


13/11/10
PY Mindmaps
Edward Stachowski – ECG tutorial (Sydney Written Course)


- pre-excitation syndrome
- additional or accessory AV pathway
- during sinus rhythm the atrial impulse will reach the ventricles via both AV node and
accessory AV pathway
- accessory pathway conducts impulse faster -> pre-excitation and short PR interval
- on reaching the ventricles the pre-excitation impulse is not conducted via the conducting
system -> ventricular activation is slow (delta wave and T wave abnormalities)


CLINICAL FEATURES

-   palpitations
-   chest pain
-   SOB
-   cardiogenic shock
-   collapse
-   VF arrest
-   AF or SVT


INVESTIGATIONS


Resting ECG

- short PR (<0.12s)
- delta wave
- wide QRS (>0.12s)

- T wave abnormalities
- dominant R in V1 and V2
- may have inferior q waves but not diagnostic of MI

Type A – tall R in V1, LAD (left posterior septal path)
Type B – deep S in V1, LAD (right lateral or postero-septal path)
Type C – tall R in V1, inferior axis - 90º (left lateral path)


Symptomatic ECG

- AV re-entrant tachycardia or AF
- AVRT: the re-entry impulse usually travels down the AV node and back up the accessory
pathway (delta wave not present), occasionally the re-entry impulse may pass down the
accessory pathway and up the AV node (wide QRS tachycardia + delta wave)
- AF: rapid, irregular QRS complexes with variable QRS duration -> very rapid ventricular
response -> cardiogenic shock -> VF


MANAGEMENT



                                                                        Jeremy Fernando (2011)
Acute

- unstable -> synchronised DC shock
- stable -> anti-arrhythmics (prolongation of accessory pathway: sotalol, amiodarone,
flecanide, procanamide)

- drugs that shorten refractory period are contraindicated (digoxin)
- drugs that increase ventricular rate avoid (verapamil and lignocaine)
- drugs that have no effect on refractory period of accessory pathway are useless (beta-
blockers)

Long-term

- radio-frequency ablation




                                                                       Jeremy Fernando (2011)

								
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