Wolff–Parkinson–White syndrome (WPW) is a ventricular pre-excitation syndrome associated with abnormal conduction pathways between the atria and ventricle. Classic findings on the ECG are the delta wave (slurred upstroke of QRS) and shortened PR interval (<120s). Tachycardias may be narrow complex (associated with anterograde conduction through accessory pathway) or wide complex (associated with retrograde conduction).
Management is based on acute vs chronic nature of tachycardia:
Acute treatment in a hemodynamically stable patient
- Regular narrow complex- treatment similar to PSVT, vagal maneuvers or IV adenosine
- Regular wide complex- IV adenosine (used with caution due to capability of rapid anterograde conduction leading to afib). Avoid AV nodal blocking agents since this may leave only the accessory pathway for conduction. Class I or II anti-arrhythmics (procainamide, sotalol or amiodarone) may be used to target accessory pathway.
Acute treatment in hemodynamically unstable patient
- DC cardioversion
- Catheter ablation of accessory tract
- Chronic AV nodal blocking agents- class I and III
- K K Sethi, A Dhall, D S Chadha, S Garg, S K Malani, O P Mathew WPW and preexcitation syndromes. J Assoc Physicians India: 2007, 55 Suppl;10-5