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Wolff-Parkinson
White
Jason Ryan, MD, MPH
WPW Syndrome
Wolff-Parkinson White Syndrome

• Cardiac electrical disorder

• “Accessory atrioventricular pathway”
• Conducts impulses from atria to ventricles
• Bypasses AV node
• “Bundle of Kent” AfraTafreeh.com
• Causes “pre-excitation”
• Ventricular depolarization before AV nodal impulse
• May lead to arrhythmias
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EKG in WPW
Short PR

Delta Wave
WPW EKG

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Cardiac Electrical System

SA

AV LBB

His
Purkinje
Fibers
RBB
AVRT
AV Re-entrant Tachycardia

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Orthodromic Antidromic
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Bypass Tract Consequences

• Most patients asymptomatic
• EKG with delta wave only
• Called WPW “pattern”
• Some have tachycardias
• Presents as palpitations
• Called WPW syndrome
• AVRT (anti or orthodromic)
• Rarely causes syncope or sudden death
• Treatment: Ablation of accessory pathway
Atrial Fibrillation in WPW
• Atrial fibrillation can be life threatening
• Atrial depolarization rate 300-500/min
• AV node conducts <200/min
• Impulses may conduct rapidly over bypass tract
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Wide complex, irregular, tachycardic

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Atrial Fibrillation in WPW

• Slowing AV node conduction is dangerous
• Allows more impulses over bypass tract
• Usual atrial fibrillation therapies contraindicated
• Beta blockers
• Calcium channel blockers
• Digoxin
• Adenosine
• Acute treatment: Cardioversion or antiarrhythmics
• Ibutilide, procainamide
• Slow conduction in bypass tract