Wolff-Parkinson-White Syndrome

Question 1

What is Wolff-Parkinson-White Syndrome (WPW)?

Answer 1

It is a congenital arrythmia caused by an accessory conducting pathway leading to an atrioventricular re-entry tachycardia (AVRT)

Question 2

What is the inheritance of Wolff-Parkinson-White syndrome?

Answer 2

Autosomal Dominant

Question 3

What is the pathway in Wolff-Parkinson-White syndrome called?

Answer 3

Bundle of Kent

Question 4

What is the pathophysiology of Wolff-Parkinson-White syndrome?

Answer 4

The accessory pathway enables electrical conduction to bypass the AV node and stimulate the proximal ventricles prematurely

This occurs in addition to normal electrical conduction through the AV node, leading to double excitation of the ventricles

Question 5

What are the two classifications of Wolff-Parkinson-White syndrome?

Answer 5

Wolff-Parkinson-White Syndrome A

Wolff-Parkinson White Syndrome B

Question 6

What is Wolff-Parkinson-White syndrome A?

Answer 6

It is defined as a left sided accessory pathway

Question 7

What is Wolff-Parkinson-White syndrome B?

Answer 7

It is defined as a right sided accessory pathway

Question 8

What are the eight risk factors associated with Wolff-Parkinson-White syndrome?

Answer 8

Middle Aged 30 – 40 Years Old

Male Gender

Family History

Ebstein’s Anomaly

Secundum Atrial Septal Defect

Hypertrophic Obstructive Cardiomyopathy

Mitral Valve Prolapse

Hyperthyroidism

Question 9

What genetic mutation is associated with Wolff-Parkinson-White syndrome?

Answer 9

PRKAG2

Question 10

What investigation is used to diagnose Wolff-Parkinson-White syndrome?

Answer 10

ECG Scan

Question 11

What are the four features of Wolff-Parkinson-White syndrome on ECG scans?

Answer 11

Short PR Interval < 120ms

Wide QRS Complex > 110ms

Delta Wave

Axis Deviation

Question 12

What is a delta wave on ECG scans?

Answer 12

It is a slurred upstroke of the QRS complex

Question 13

What are the three specific features of Wolff-Parkinson-White A on ECG scans?

Answer 13

Right Sided Axis Deviation

Positive Delta Waves V1 – V6

Dominant R Wave V1

Question 14

What are the three specific features of Wolff-Parkinson-White B on ECG scans?

Answer 14

Left Sided Axis Deviation

Negative Delta Waves V1 – V2

No Dominant R Wave V1

Question 15

What are the three pharmacolgoical management options used to manage Wolff-Parkinson White syndrome?

Answer 15

Sotalol

Amiodarone

Flecainide

Question 16

When is sotalol contraindicated in Wolff-Parkinson-White syndrome? Why?

Answer 16

In Wolff-Parkinson-White syndrome patients, who have a co-existent diagnosis of atrial fibrillation

This is due to the fact that prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing ventricular rate and potentially deteriorating into ventricular fibrillation

Question 17

What is the definitive management option of Wolff-Parkinson-White syndrome?

Answer 17

Radiofrequency Ablation

Question 18

What is radiofrequency ablation?

Answer 18

It involves the application of heat to burn out the abnormal area of electrical activity

This leaves scar tissue that doesn’t transmit electrical activity

Question 19

What investigation is conducted prior to radiofrequency ablation?

Answer 19

Catheter Ablation

Question 20

What is catheter ablation?

Answer 20

It involves the insertion of a catheter into the femoral veins and feeding a wire through the venous system under x-ray guidance to the heart

Once in the heart it is placed against different areas to test the electrical signals at that point