Wolff-Parkinson-White Syndrome

Question 1

Define Wolff-Parkinson-White Syndrome (WPW Syndrome)?

Answer 1

A congenital abnormality which can result in supraventricular tachycardias that use an accessory pathway
It is a pre-excitation syndrome

Question 2

What is the aetiology of WPW Syndrome?

Answer 2

The accessory pathway (bundle of Kent) is likely to be congenital

Question 3

What are the associations of WPW Syndrome?

Answer 3

Congenital Cardiac Defects
Ebstein’s anomaly
Mitral Valve prolapse
Cardiomyopathies (e.g. HOCM)

Question 4

What is Ebstein’s anomaly?

Answer 4

Congenital malformation of the heart characteristed by displacment of septal and posterior tricuspid leaflets

Question 5

What is the epidemiology of WPW Syndrome?

Answer 5

Relatively Common
Most common of the ventricular pre-excitation syndromes 
Found in all ages 
More common in the young 
Prevalance decreases with age

Question 6

What are the presenting symptoms of WPW Syndrome?

Answer 6

SVT may occur in early childhood
Often asymptomatic - may be an incidental finding of an ECG
General Symptoms
Paroxysmal SVT may be followed by a period of polyuria, due to arial dilatation and release of ANP
Sudden death, if SVT deteriorates into VF
Clinical features of associated cardiac defects (e.g. mitral valve prolapse, cardiomyopathy)

Question 7

What are some of the general symptoms of WPW Syndrome?

Answer 7

Palpitations
Light-Headedness
Syncope

Question 8

What investigations would you do for WPW Syndrome?

Answer 8

ECG
Bloods
Echocardiogram

Question 9

What are the features of an ECG for WPW Syndrome?

Answer 9

May be normal if the conduction speed of the impulse along the accessory pathway matches the conduction speed down the Bundle of His 
Some Classic ECG Findings: 
Short PR interval
Broad QRS complex 
Slurred upstroke producing a delta wave 

Patient may be in SVT (AVRT)

Question 10

Why do we do Blood investigation for WPW Syndrome?

Answer 10

Check for other causes of arrhythmia