WPW Syndrome

HISTOR
Y
Named after three
scientists
• WOLFF
• PARKINSON
• WHITE
(In the year 1930)
INTRODUCTION
Wolff–Parkinson–White syndrome (WPW) a pre-
excitation syndrome is caused by the presence of an
abnormal accessory
electrical conduction
pathway between the atria
and the ventricles.
This is often congenital

The anomalous bypass, also known as the
Bundle of Kent, is a thin filamentous structure
ectopically anywhere along the
atrioventricular ring.
MAIN SITES OF BYPASS TRACTS
Left lateral pathway
45%
Posteroseptal pathway(r/l)
26%
Right lateral pathway
18%
Anteroseptal pathway(r/l)
9%
PATHWAY
S
SIGNS AND
SYMPTOMS
People with WPW are usually asymptomatic.
However, the individual may experience.
• palpitations,
• dizziness,
• shortness of breath,
• syncope
• sweating
ECG PRESENTATION
• Short PR interval
• Slurred initial upstroke of QRS – delta
wave
• Relatively normal , narrow terminal QRS
–main QRS deflection
• Slight widening of QRS
• Secondary ST changes
ECG simulation by WPW
• Right ventricular hypertrophy.
• Anterior / Post myocardial infarction. (left
lateral)
• Inferior wall myocardial infarction. (right
posteriorseptal)
• Bundle branch blocks.
• Ventricular tachycardia.
• Primary myocardial disease.
CASE 1
• Ullas R 22yrs of age came with C/O
• Palpitations since childhood.Palpitations
are triggered by exertion(minimal), fever,
emotional disturbances and few occasions
at rest.
• No H/O RHD, CTD, DM2, Hypertension,
TB, epilepsy.
• Patient referred for abnormal ECG by
local doctor.
O/E
VITALS : PR 117 bpm, regular rhythm, normal
character.
BP 110/80 mm Hg
Temp Afebrile
Resp. rate 20 bpm
SP O2 96% with out
O2
C.V.S. S1S2 heard,
no murmurs heard
R.S. NVBS heard,
no added sounds
heard.
A standard 12 lead
ECG showing
□ Sinus rhythm
□ Heart rate 117
bpm
□Regular rhythm
without significant
variation in R-R
interval
□ PR interval 0.06
sec
□QRS duration 0.12
sec
□QTc interval 0.38
sec
□P wave axis 40* to
60*
□ QRS axis -40*to
DIAGNOSIS Wolff-Parkinson-White Syndrome
(right posteroseptal/ right lateral)
(accessory pathway)
CASE 2
A 45 YR old female presented with
• Difficulty in breathing
• Palpitation
• Sweating for past 4 hours
□ Normal sinus rhythm □ QTC 0.40 sec
FINDING □ Rate 80 / min □Delta wave noticed(slurred
□ Axis normal QRS upstroke)
S □ PR shortened 0.08 sec
□ Broad QRS complex
□ Terminal QRS normal
□Secondary ST/T changes
□ QRS duration 0.12 sec seen
DIAGNOSIS
WPW SYNDROME
POSSIBLE PATHWAYS
• Right posteroseptal
• Anteroseptal
COMPLICATIONS
• Tachyarrhythmia
• Syncopal attacks
• Sudden cardiac death
• Complications of drug therapy (eg,
proarrhythmia, organ toxicity)
• Complications associated with invasive
procedures and surgery
• Recurrence
TREATMEN
T
RADIOFREQUENCY ANTIARRYTHMICS–
ABLATION ( TOC) class 1c, 3
SURGICAL ABLATION (
OUTDATED)
➢ The drug of choice for the treatment of regular
supraventricular (reciprocating) tachycardia with narrow
QRS complexes, which is the most common arrhythmia
in the WPW syndrome, is propranolol. Digitalis is
almost equally effective in this case.
➢ For tachyarrhythmias, particularly atrial fibrillation or
flutter with anomalous conduction, intravenously-
administered lidocaine is considered to be the drug of
choice. Procainamide or quinidine is also frequently used
under this circumstance with excellent therapeutic result.
➢ Many patients with the WPW syndrome require long-
term maintenance drug therapy (propranolol, digitalis
or quinidine in most cases). In urgent clinical
situations, direct current (DC) shock should be applied
immediately.
➢ In selected patients with refractory tachyarrhythmias, the
use of an artificial pacemaker or surgical approach may be
considered.
CAUTION
• Usual presentation is SVT
• Sudden cadiac death possible
• Digoxin, beta blockers,verapamil are
contraindicated
• Underlying Ebstein’s anomaly,
hypertrophic cardiomyopathy should be
evaluated/
THANK YOU
FOR YOUR
ATTENTION
!

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HISTOR

This is often congenital

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