Wolff-Parkinson-White
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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. 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