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

Images: Related links to external sites (from Google)

Ontology: Wolff-Parkinson-White Syndrome (C0043202)

Definition (NCI) A type of ventricular pre-excitation resulting from the activation of an accessory pathway known as the Bundle of Kent. This pathway presents an abnormal electrical communication from the atria to the ventricles. Wolff-Parkinson-White syndrome is characterized by a short PR interval and a long QRS interval with a delta wave. (NCI)
Definition (NCI) A congenital electrical function abnormality in the heart. It is characterized by the presence of an accessory conductive pathway between the atria and the ventricles which causes the activation of the ventricles earlier than anticipated. Characteristic electrocardiographic findings are a short PR interval and a wide QRS complex with a delta wave.
Definition (NCI) A disorder characterized by the presence of an accessory conductive pathway between the atria and the ventricles that causes premature ventricular activation.
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 (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, 155360000, 266304003, 251115003
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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, WPW syndrom, Wolf-Parkinson-Whiteův syndrom
Spanish Wolff-Park-White syndr., Wolff - Parkinson - White syndrome, Wolff-Parkinson-White syndrome, preexcitación ventricular con arritmia, síndrome de Wolff - Parkinson - White (trastorno), síndrome de Wolff - Parkinson - White, patrón Wolff-Parkinson-White (hallazgo), patrón Wolff-Parkinson-White, Síndrome congénito de Wolff-Parkinson-White, Sindrome de Wolff-Parkinson-White, Sindrome WPW, Síndrome de Wolff-Parkinson-White, Síndrome WPW
Finnish Wolff-Parkinson-Whiten oireyhtymä
Polish Zespół WPW, Zespół Wolffa-Parkinsona-White'a
Hungarian WPW syndroma, Wolff-Parkinson-White syndroma, Veleszületett Wolff-Parkinson-White syndroma
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