Rapid Review: Wolff-Parkinson-White (WPW) Syndrome

September 28, 2017

Reviewed January 2024

Wolff-Parkinson-White (WPW) Syndrome

  • ECG will show short PR interval, delta wave, wide QRS
  • Most commonly caused by an accessory pathway (bundle of Kent) connecting atria to ventricles, bypassing AV node
  • Acute treatment:
    • Orthodromic (narrow complex): vagal maneuvers, AV nodal blockers (adenosine, beta-blocker, calcium channel blocker)
    • Antidromic (wide complex): procainamide
    • Synchronized cardioversion for hemodynamically unstable patients
  • Definitive treatment is radiofrequency ablation

Sample question:

A 23-year-old man presents to your clinic with intermittent episodes of chest discomfort, heart palpitations, and decreased exercise tolerance. Which of the following ECG findings would most strongly suggest a diagnosis of Wolff-Parkinson-White syndrome?

By Yehuda Wolf, MPA, PA-C

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