Wolff-Parkinson-White syndrome diagnosis overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]

Overview

The diagnose of WPW pattern is commonly made by an incidental ECG finding in an asymptomatic individuals. The characteristic EKG finding is a delta wave, which represents the pre-excitation of the ventricles through the accessory pathway. This phenomenon presents because the AV node has the property of slowing the impulses, therefore the conduction through the accessory pathway is faster, therefore the ventricles are excited through two different pathways. The delta wave is an upstroke in the R wave of the QRS complex that is associated with a short PR interval. Delta waves are only present when the patient is in sinus rhythm, whentachycardia starts the delta wave is no longer present. Patients WPW syndrome with episodes of atrial fibrillation will present ECG with rapid irregular wide-complex tachycardia. The combination of atrial fibrillation and WPW may increase the risk of very rapid antidromic AVRT and occurrence of ventricular fibrillation. AV node blocking agents are contraindicated in these patients because it will enhance the conduction through the accessory pathway. Patients with WPW may exhibit more than one accessory pathway which is common in patients with Ebstein’s anomaly.

The diagnose of WPW pattern is commonly made by an incidental ECG finding in an asymptomatic individuals.
The characteristic EKG finding is a delta wave, which represents the pre-excitation of the ventricles through the accessory pathway
This phenomenon presents because the AV node has the property of slowing the impulses, therefore the the conduction throuhg the accessory pathway is faster, therefore the ventricles are excited through two different pathways.^[1]
The delta wave is an upstroke in the R wave of the QRS complex that is associated with a short PR interval.
Delta waves are only present when the patient is in sinus rhythm, whentachycardia starts the delta wave is no longer present.
Patients WPW syndrome with episodes of atrial fibrillation will present ECG with rapid irregular wide-complex tachycardia.^[2]
The combination of atrial fibrillation and WPW may increase the risk of very rapid antidromic AVRT and occurrence of ventricular fibrillation.
AV node blocking agents are contraindicated in these patients because it will enhance the conduction through the accessory pathway.
Patients with WPW may exhibit more than one accessory pathway which is common in patientds with Ebstein’s anomaly.^[3]
The most common combination of accessory pathways in Ebstein anomaly was the right posteroseptal and right free wall pathway.
Wolff-Parkinson-White syndrome is sometimes associated with Leber’s hereditary optic neuropathy (LHON), a form of mitochondrial disease.^[4]^[5]

One beat from a rhythm strip in V₂ demonstrating characteristic findings in WPW syndrome. Note the characteristic delta wave (subtler here than in some cases), the short PR interval of 0.08 seconds, and the long QRS complex at 0.12 seconds.

↑ Sethi, KK.; Dhall, A.; Chadha, DS.; Garg, S.; Malani, SK.; Mathew, OP. (2007). “WPW and preexcitation syndromes”. J Assoc Physicians India. 55 Suppl: 10–5. PMID 18368860. Unknown parameter |month= ignored (help)
↑ Fengler, BT.; Brady, WJ.; Plautz, CU. (2007). “Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED”. Am J Emerg Med. 25 (5): 576–83. doi:10.1016/j.ajem.2006.10.017. PMID 17543664. Unknown parameter |month= ignored (help)
↑ “Radiofrequency ablation of multiple accessory pathways”. Retrieved 14 April 2014.
↑ Nikoskelainen, EK.; Savontaus, ML.; Huoponen, K.; Antila, K.; Hartiala, J. (1994). “Pre-excitation syndrome in Leber’s hereditary optic neuropathy”. Lancet. 344 (8926): 857–8. PMID 7916404. Unknown parameter |month= ignored (help)
↑ Mashima Y, Kigasawa K, Hasegawa H, Tani M, Oguchi Y. (1996). “High incidence of pre-excitation syndrome in Japanese families with Leber’s hereditary optic neuropathy” (subscription required). Clinical Genetics. 50 (6): 535–7. PMID 9147893.