Wolff-Parkinson-White

Only really important because consultants and examiners like to ask questions on it. And the whole sudden death thing.

Definition

An abnormal accessory pathway between the atrium and ventricle. (It's also called a pre-excitation syndrome)

Epidemiology

0.1-0.3% of the general population.

Pathophysiology

There is an extra electrical pathway between atrium and ventricle. This is called the bundle of Kent. The reason it's important is because of a predisposition to sudden death. This is the bit you should know.

Left is called "type A pre-excitation", right "type B pre-excitation "

Clinical Features

Mostly asymptomatic. Occasionally, palpitations or sudden death (if you're really unlucky). But general cardiac symptoms (shortness of breath, dizziness or syncope)

Investigations

ECG

• Delta wave - the R wave doesn't just go straight up. There's a slight kink. See the picture on the right (when I eventually insert it.)
• PR<0.12s
• Cardiac electrophysiology - an invasive and very clever ECG

Management

• If unstable - cardioversion
• Amiodarone or procainamide
• ablation