Wolff Parkinson White (SVT)

Question 1

What is WPW

Answer 1

SVT caused by a congenital accessory pathway (Bundle of KENT) which bypasses the AV node (presenting reentrant rhythm)

Question 2

Who is most affected in WPW

Answer 2

Men 2:1

Question 3

What are the clinical features of WPW

Answer 3

Asymptomatic
Palpitation
Dizziness
Syncope

Question 4

What are the ECG features of WPW

Answer 4

Delta Wave (Pre excitation)
Short PR
Broad QRS
May show narrow complex Tachycardia

Question 5

What is the difference between narrow and broad complex tachycardia

Answer 5

Both have more than 100 bpm
Narrow = QRS <120ms
Broad = QRS >120ms

Question 6

What investigations can be used to diagnose WPW

Answer 6

ECG
24hr ECG monitoring
Bloods
ECHO (ventricular function)
Electrophysiological studies (map the accessory pathway)

Question 7

How would you manage WPW

Answer 7

Ablation of the accessory pathway
Amiadarone/Sotalol
Surgical ablation (rare)

Question 8

What drugs are Contraindicated in WPW and why

Answer 8

Digoxin and NDP-CCB

May precipitate VF

Question 9

How would you manage unstable WPW patients

Answer 9

Urgent DC Cardioversion

Question 10

How would you manage stable WPW patients

Answer 10

1st) Valsalva/Carotid sinus manouvre
2nd) IV adenosine
Radiofrequency ablation of Bundle of Kent

Question 11

What is the diagnostic for WPW

Answer 11

ECG

• Delta wave
• Short PR
• Wide QRS