Wolff-Parkinson-White (WPW) Syndrome on ECG

Introduction

Wolff-Parkinson-White (WPW) syndrome is a condition in which an additional electrical pathway (accessory pathway) exists in the heart, leading to abnormal conduction of impulses. This can result in episodes of tachycardia (rapid heart rate) and other arrhythmias.

ECG Characteristics of WPW

An electrocardiogram (ECG) is the primary tool for diagnosing WPW. The key features of WPW on an ECG include:

  1. Shortened PR Interval (< 120 ms) – This occurs because impulses bypass the AV node and directly stimulate the ventricles.
  2. Delta Wave – A slurred upstroke at the beginning of the QRS complex due to early ventricular activation.
  3. Widened QRS Complex (> 120 ms) – This results from the abnormal conduction through the extra pathway.
  4. Possible Arrhythmias – WPW can be associated with atrial fibrillation or AV reentrant tachycardia (AVRT).

Clinical Significance

  • WPW can lead to life-threatening arrhythmias in some cases, especially if atrial fibrillation is present and conducting rapidly to the ventricles.
  • Symptoms include palpitations, dizziness, syncope (fainting), and, in severe cases, sudden cardiac arrest.
  • Some individuals with WPW may remain asymptomatic.

Management

  • Asymptomatic WPW: In some cases, no treatment is needed, but risk assessment may be necessary.
  • Symptomatic WPW: First-line treatment includes catheter ablation to eliminate the accessory pathway.
  • Medications: In certain cases, antiarrhythmic drugs, such as procainamide, may be used, but AV nodal blocking agents should be avoided in atrial fibrillation due to the risk of dangerous ventricular rates.

Conclusion

WPW is a potentially serious condition that requires careful assessment and management. If diagnosed on ECG, consultation with a cardiologist or electrophysiologist is recommended.

Source recommendations

1. ESC Guidelines on Supraventricular Tachycardia

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  2. https://academic.oup.com/eurheartj/article/41/5/655/5556821
  3. https://pubmed.ncbi.nlm.nih.gov/31504425/
  4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2019/09/10/12/36/2019-ESC-Guidelines-for-Supraventricular-Tachycardia
  5. https://www.ahajournals.org/doi/10.1161/cir.0000000000000311

2. ACC/AHA/HRS Guideline for the Evaluation and Management of Supraventricular Tachycardia

  1. https://www.ahajournals.org/doi/10.1161/cir.0000000000000311
  2. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2015/09/23/09/13/2015-ACC-AHA-HRS-Guideline-for-the-Management-of-Adult-Patients-With-SVT
  3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000310
  4. https://www.heartrhythmjournal.com/article/s1547-5271(15)01189-3/fulltext
  5. https://professional.heart.org/en/science-news/-/media/028ddd505f514ea2b3a4e74bb72e3557.ashx

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