Wolff-Parkinson-White Syndrome

Question 1

Cause and what

Answer 1

Congenital accessory conduction pathway between atria and ventricles leading to atrioventricular re-entry tachycardia (AVRT)

Question 2

Why problem?

Answer 2

Accessory pathway does not slow conduction. AF can quickly become VF

Question 3

Associations

Answer 3

Hypertrophic obstructive cardiomyopathy
Mitral valve prolapse
Ebstein's anomaly
Thyrotoxicosis
ASD

Question 4

ECG changes

Answer 4

Short PR interval
Broad QRS due to delta wave - "slurred upstroke"
ST-changes
Deviation to side of accessory pathway (usually left)
Type A (LEFT sided): prominent R wave in V1
Type B (Right sided): no prominent R wave in V1

Question 5

Presentation

Answer 5

SVT - may be due to AVRT, pre-excited AF or pre-excited atrial flutter

Question 6

Management

Answer 6

Refer to cardiologist for electrophysiology and treatment
Definitive treatment: radiofrequency ablation of the accessory pathway
Medical management: sotalol (avoid if in AF - might precipitate VF!!), amiodarone, flecainide