Often asymptomatic unless an arrhythmia develops.
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WPW Pattern 🆚 WPW syndrome
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Wolff-Parkinson-White (WPW) syndrome and pattern
ECG Findings
ECG patterns in Wolff-Parkinson-White syndrome | Delta wave present | QRS complex width | AV node dependence | Acute treatment |
---|---|---|---|---|
Sinus rhythm | Yes | Wide | Yes | NA |
AV reentrant tachycardia | No | Usually narrow | Yes | Vagal maneuvers or adenosine* |
Preexcited atrial fibrillation | Intermittently | Wide | No** | Procainamide* |
Immediate synchronized cardioversion is indicated for hemodynamic instability.
**Absence of AV node dependence creates risk of extremely high ventricular rates.
Unstable Arrhythmia
<aside> ⛔ Both C.I. with irregular rhythm [eg, AF] → because AV-node blockers promote more conduction through the accessory pathway → ↑ rapid ventricular response.
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**Antidromic AVRT or Atrial Fibrillation (wide complex)**
Definitive Therapy
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What is the recommended temporary management for a hemodynamically stable Wolff-Parkinson-White syndrome patient with atrial fibrillation?
Wolff-Parkinson-White syndrome is a common cause of AVRT but they are not synonymous WPW is an ECG pattern based on an aberrant pathway, AVRT is a complication in form of arrhythmia.
Type | ECG Findings |
---|---|
Orthodromic AVRT | 🔷 Heart rate 150–250/minute |
🔷 Regular rhythm | |
🔷 Narrow QRS complex | |
🔷 P wave typically follows QRS complex. | |
🔷 Can be indistinguishable from AVNRT | |
Antidromic AVRT | 🔷 Heart rate 150–250/minute |
🔷 Regular rhythm | |
🔷 Wide QRS complex (similar in appearance to ventricular tachycardia, preexcited focal atrial tachycardia, and preexcited atrial flutter) | |
🔷 Shortened PR interval |
Orthodromic and antidromic AVRT
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During an attack of tachyarrythmia → delta waves and delta waves may not be present!
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AVRT is caused by an accessory pathway, whereas in AVNRT there are two functional pathways within the AV node.
Brugada pattern