I. Definition

  1. Arrhythmia associated with AV bypass tract

II. Epidemiology

  1. Prevalence: 2 per 1000 general population

III. Pathophysiology

  1. Atrioventricular bypass tract
    1. Circumvents normal PR interval delay (up to 0.2 sec)
    2. Allows for ventricular pre-excitation
  2. Predisposes to arrhythmia
    1. Reentrant Paroxysmal Supraventricular Tachycardia
    2. Paroxysmal Atrial Fibrillation

IV. Findings: EKG changes (variably present)

  1. Wide QRS (to extent that PR interval is narrowed)
  2. Narrow PR interval
    1. Due to pre-excitation of ventricle
    2. Look closely for Delta wave when a narrow PR interval is identified on EKG
  3. Delta wave
    1. Slurred upstroke of QRS (hockey stick appearance)

V. Differential Diagnosis

  1. Right or Left Bundle Branch Block (wide complex)
  2. Myocardial Infarction (Q Wave when QRS negative)

VI. Precautions

  1. Do not use Digoxin or Verapamil with WPW
    1. May accelerate arrhythmia via accessory path
  2. Have a high index of suspicion in young patients with Syncope
    1. WPW may be present despite an absence of Short PR Interval and a Delta Wave
  3. Sinus Tachycardia can still occur with all of the typical reasons seen in patients without WPW
    1. Consider dehydration, infection, Pulmonary Embolism in the differential in a patient with WPW and Tachycardia

VII. Management

VIII. References

  1. Braude, Swadron and Orman et. al. in Majoewsky (2012) EM:RAP 12(7): 1-2
  2. Goldberger (1999) Clinical Electrocardiography, p 127-8
  3. Grauer (2001) 12 Lead EKG, p. 27

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Ontology: Wolff-Parkinson-White Syndrome (C0043202)

Definition (MSH) A form of ventricular pre-excitation characterized by a short PR interval and a long QRS interval with a delta wave. In this syndrome, atrial impulses are abnormally conducted to the HEART VENTRICLES via an ACCESSORY CONDUCTING PATHWAY that is located between the wall of the right or left atria and the ventricles, also known as a BUNDLE OF KENT. The inherited form can be caused by mutation of PRKAG2 gene encoding a gamma-2 regulatory subunit of AMP-activated protein kinase.
Definition (MSHCZE) Typ arytmie s předčasnou aktivací srdeční komory cestou akcesorního Kentova svazku. Onemocnění je vrozené a projevuje se někdy paroxysmy či fibrilací síní, které mohou narušit funkci srdce. Patří k typu arytmie zvanému preexcitace. Na EKG se projevuje zkrácením intervalu PQ, resp. PR (předčasná aktivace komor), popř. i vlnou delta (předčasné šíření vzruchu v komorách), která rozšiřuje komorový komplex. (cit.: Velký lékařský slovník on-line, 2013, http://lekarske.slovniky.cz/ )
Definition (NCI) A cardiac conduction disorder characterized by an electrocardiographic finding of ventricular pre-excitation, which is a short PR interval and a long QRS interval with a delta wave. Most individuals are asymptomatic; however they can experience periods of palpitations, shortness of breath or syncope during tachycardic episodes.
Definition (NCI_CTCAE) A disorder characterized by the presence of an accessory conductive pathway between the atria and the ventricles that causes premature ventricular activation.
Definition (NCI_CDISC) An electrocardiographic finding of ventricular pre-excitation. The syndrome is characterized by a short PR interval and a long QRS interval with a delta wave.
Definition (CSP) association of paroxysmal tachycaria or atrial fibrillation and pre-excitation characterized by a short PR interval and a long QRS interval with a delta wave.
Concepts Disease or Syndrome (T047)
MSH D014927
ICD10 I45.6
SnomedCT 74390002, 251115003, 155360000, 266304003
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Italian Sindrome di Wolff-Parkinson-White congenita, Sindrome di WPW, Sindrome di Wolff-Parkinson-White
Dutch syndroom van WPW, syndroom van Wolff-Parkinson-White, syndroom van Wolff-Parkinson-White, congenitaal, Syndroom, Wolff-Parkinson-White-, WPW-syndroom, Wolff-Parkinson-White-syndroom
Japanese 先天性ウォルフ・パーキンソン・ホワイト症候群, ウォルフ・パーキンソン・ホワイト症候群, WPW症候群, ウォルフパーキンソンホワイトショウコウグン, センテンセイウォルフパーキンソンホワイトショウコウグン, WPWショウコウグン, ウルフ・パーキンソン・ホワイト症候群, ウォルフ・パーキンソン・ホワイト症候群, Wolff-Parkinson-White症候群, WPW症候群, ウォルフ-パーキンソン-ホワイト症候群, 副伝導路症候群, 心室早期興奮症候群, ウルフ-パーキンソン-ホワイト症候群
Swedish Wolff-Parkinson-Whites syndrom
Czech Wolffův-Parkinsonův-Whiteův syndrom, Vrozený Wolff-Parkinson-Whiteův syndrom, Wolf-Parkinson-Whiteův syndrom, syndrom Wolffův-Parkinsonův-Whiteův, WPW syndrom
Finnish Wolff-Parkinson-Whiten oireyhtymä
Russian VOL'FA-PARKINSONA-UAITA SINDROM, ВОЛЬФА-ПАРКИНСОНА-УАЙТА СИНДРОМ
Polish Zespół WPW, Zespół Wolffa-Parkinsona-White'a
Hungarian WPW syndroma, Wolff-Parkinson-White syndroma, Veleszületett Wolff-Parkinson-White syndroma
Spanish síndrome de Wolff - Parkinson - White (trastorno), patrón de Wolff-Parkinson-White, síndrome de Wolff - Parkinson - White, patrón de Wolff-Parkinson-White (trastorno), síndrome de Wolff-Parkinson-White (trastorno), síndrome de Wolff-Parkinson-White, patrón Wolff-Parkinson-White (hallazgo), patrón Wolff-Parkinson-White, preexcitación ventricular con arritmia, Síndrome congénito de Wolff-Parkinson-White, Síndrome de Wolff-Parkinson-White, Síndrome WPW
Norwegian Wolff-Parkinson-Whites syndrom, Aksessoriske ledningsbaner av WPW-type
Portuguese Síndroma de Wolff-Parkinson-White, Síndrome de Wolff-Parkinson-White congénito, Síndrome de Wolff-Parkinson-White, Síndrome WPW
French Syndrome de Wolff-Parkinson-White congénital, Syndrome de Wolff-Parkinson-White, Syndrome WPW, Syndrome de WPW
German Wolff-Parkinson-White Syndrom kongenital, WPW-Syndrom, Wolff-Parkinson-White-Syndrom