Arrhythmias - Wolff-Parkinson White Syndrome

Question 1

Pathophysiology of Wolff-Parkinson White Syndrome.

Answer 1

Accessory Congenital Electrical Pathway connecting the atria and ventricles (in addition to AV Node = Bundle of Kent), leading to supra ventricular tachycardias.

Question 2

Clinical Presentation of Wolff-Parkinson White Syndrome (4).

Answer 2

1. Asymptomatic.
2. Palpitations.
3. Dizziness.
4. Syncope.

Question 3

Associations of Wolff-Parkinson White Syndrome (5).

Answer 3

1. HOCM.
2. Mitral Valve Prolapse.
3. Ebstein’s Anomaly.
4. Thyrotoxicosis.
5. Secundum ASD.

Question 4

ECG Changes in Wolff-Parkinson White Syndrome (4).

Answer 4

1. Short PR Interval (<0.12 seconds).
2. Wide QRS Complex (>0.12 seconds).
3. DELTA WAVE - slurred upstroke on QRS Complex.
4. LAD + No Dominant R V1 Wave if Right-Sided Accessory Pathway and RAD + Dominant R V1 Wave if Left-Sided Accessory Pathway.

Question 5

Management of Wolff-Parkinson White Syndrome (2)

Answer 5

1. Definitive : Radiofrequency Ablation of Accessory Pathway.
2. Medical : Sotalol, Amiodarone, Flecainide.

Question 6

What is the risk of having both AF/Flutter with WPW?

Answer 6

1. Chaotic atrial electrical activity can pass through the accessory pathway into the ventricles = polymorphic wide-complex tachycardia (VF).
2. Anti-arrhythmic drugs usually used in AF reduce conduction through the AV node and promote it through the accessory pathway : contraindication.