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Mgmt: WPW

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 thismay 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

Chronic treatment

  • Catheter ablation of accessory tract
  • Chronic AV nodal blocking agents- class I and III


  1. 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 PubMed Link

Other References

  1. Keys to the Cart: March 26, 2018; a 5-minute video review of ABA Keywords Link
  2. Keys to the Cart: April 2, 2018; a 5-minute video review of ABA Keywords Link