Wolff-Parkinson-White (WPW) Syndrome

Definition

Pre-excitation disorder of the cardiac conduction system, predisposing one to re-entrant tachyarrhythmias.

History and Physical Exam

Often asymptomatic, but may have history suggestive of tachyarrhythmias: palpitations, chest pain, SOB, dizziness and/or syncope.

Key 12-Lead Features

Short PR interval and characteristic Delta wave.

During captured AVRT episodes: orthodromic WPW is a Narrow Complex Tachycardia and looks like an SVT; antidromic WPW is a Wide Complex Tachycardia and looks like VT.

Key Treatment Points

No adenosine with concurrent Atrial-Fibrillation (or any irregular rhythm)

If unstable, proceed directly to electrical cardioversion

12 Lead ECG Samples

Orthodromic WPW tachycardia episode

Antidromic WPW tachycardia episode

Delta Wave

Further Reading

Reference

1. Stroobandt RX, et al. ECG from Basics to Essentials: Step by Step. 2015. [Link]