Wolff Parkinson White syndrome

Question 1

What is Wolff Parkinson White syndrome?

Answer 1

A congenital abnormality which can result in supraventricular tachycardias that use an accessory pathway.
Pre-excitation syndrome.

Question 2

What is a pre-excitation syndrome?

Answer 2

early activation of the ventricles due to impulses bypassing the AV node via an accessory pathway.

Question 3

Describe the aetiology of Wolff Parkinson White syndrome

Answer 3

Accessory pathway (bundle of Kent) is likely to be congenital

Question 4

List 4 associations of Wolff Parkinson White syndrome

Answer 4

Congenital cardiac defects
Ebstein’s anomaly (congenital)
Mitral valve prolapse
Cardiomyopathies (e.g. HOCM)

Question 5

Describe the epidemiology of Wolff Parkinson White syndrome

Answer 5

Relatively COMMON  
Most common of the ventricular pre-excitation syndromes  
Found in ALL AGES  
YOUNG > OLD
Prevalence decreases with age

Question 6

Give 2 symptoms of Wolff Parkinson White syndrome

Answer 6

Palpitations

Light-headedness

Question 7

Give 3 signs of Wolff Parkinson White syndrome

Answer 7

Paroxysmal SVT may be followed by a period of polyuria, due to atrial dilatation + release of ANP
Syncope
Clinical features of associated cardiac defects (e.g. mitral valve prolapse, cardiomyopathy)

Question 8

Describe ECG findings in Wolff Parkinson White syndrome

Answer 8

ECG may be normal if the conduction speed of the impulse along the accessory pathway matches the conduction speed down the bundle of His.
Patient may be in SVT (AVRT)

Question 9

What are the classic ECG signs of Wolff Parkinson White syndrome?

Answer 9

Short PR interval
Broad QRS complex
Slurred upstroke in initial portion of QRS producing a delta wave (as ventricles are being excited over a longer period of time)
DELTA + TACHY

Question 10

What investigations may be performed in Wolff Parkinson White syndrome?

Answer 10

Bloods: identify other causes of arrhythmia
Treadmill exercise test
Echo

Question 11

What structural heart defects may be found on echo in Wolff Parkinson White syndrome? (associated risk 7-20%)

Answer 11

Coronary artery disease  
Cardiomyopathy  
Valvular heart disease  
Long QT syndrome  
Brugada syndrome

Question 12

How may Wolff Parkinson White be diagnosed?

Answer 12

SVT may occur in early childhood

Often ASYMPTOMATIC; may be an incidental finding of an ECG

Question 13

Why is Wolff-Parkinson-White syndrome dangerous?

Answer 13

May lead to sudden death if SVT deteriorates into VF