Wolff–Parkinson–White syndrome - Revision history

Danbot: Add MedicationDose entry (procainamide) with SMW annotations

2026-03-20T18:43:50Z

Add MedicationDose entry (procainamide) with SMW annotations

@@ Line 117: / Line 117: @@
 **Consider higher joule dosage and frequency of repeats than for stable
 *'''Avoid''' AV nodal blocking agents
 ==Disposition==

NoahBeggs: Fixed minor typo (V! to V1), under Type B in "Types by Aberrant Pathway Site"

2022-03-28T18:03:49Z

Fixed minor typo (V! to V1), under Type B in "Types by Aberrant Pathway Site"

← Older revision		Revision as of 18:03, 28 March 2022
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	*Type B		*Type B
	**Pathway between the ''right'' atrium and ventricle		**Pathway between the ''right'' atrium and ventricle
	**Delta wave and QRS complex predominantly negative in V! and V2		**Delta wave and QRS complex predominantly negative in V1 and V2
	**Delta wave and QRS complex predominantly positive in other precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>		**Delta wave and QRS complex predominantly positive in other precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>
	**Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>		**Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>

Shihabali: /* Antidromic */

2019-11-28T03:40:48Z

Antidromic

← Older revision		Revision as of 03:40, 28 November 2019
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	**Adult: 50-100 J		**Adult: 50-100 J
	**Peds: 0.5-2 J/kg		**Peds: 0.5-2 J/kg
	**[[Procainamide]]~~: 20-50mg/min IV over 30min~~ (~~up to 17mg/kg, hypotension, or 50% widening of QRS complex~~)~~; maintenance 1-4 mg/min~~		**[[Procainamide]] (see page for dosing guidelines)
	***Avoid if prolong QT or CHF		***Avoid if prolong QT or CHF
	**[[Amiodarone]] with 'ABCD' drugs ie [[adenosine]], [[beta-blockers]], [[calcium-channel blockers]], [[digoxin]]		**[[Amiodarone]] with 'ABCD' drugs ie [[adenosine]], [[beta-blockers]], [[calcium-channel blockers]], [[digoxin]]

ClaireLewis: /* Management */

2019-09-26T19:10:01Z

Management

← Older revision		Revision as of 19:10, 26 September 2019
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	''Treat like paroxysmal SVT''		''Treat like paroxysmal SVT''
	*Unstable		*Unstable
	**Cardioversion (synchronized)		**[[Cardioversion]] (synchronized)
	**Adult: 50-100 J		**Adult: 50-100 J
	**Peds: 0.5-2 J/kg		**Peds: 0.5-2 J/kg
	*Stable		*Stable
	**Calcium channel blockers, beta-blockers, procainamide, or adenosine		**[[Calcium channel blockers]], [[beta-blockers]], [[procainamide]], or [[adenosine]]
	**Procainamide safe irrespective of type of pathway conduction		**[[Procainamide]] is safest, as safe irrespective of type of pathway conduction

	===Antidromic===		===Antidromic===
	''Treat like ventricular tachycardia''		''Treat like [[ventricular tachycardia]]''
	*Synchronized cardioversion		*Synchronized [[cardioversion]]
	**Adult: 50-100 J		**Adult: 50-100 J
	**Peds: 0.5-2 J/kg		**Peds: 0.5-2 J/kg
	**Procainamide: 20-50mg/min IV over 30min (up to 17mg/kg, hypotension, or 50% widening of QRS complex); ~~mainenance~~ 1-4 mg/min		**[[Procainamide]]: 20-50mg/min IV over 30min (up to 17mg/kg, hypotension, or 50% widening of QRS complex); maintenance 1-4 mg/min
	***Avoid if prolong QT or CHF		***Avoid if prolong QT or CHF
	**Amiodarone with 'ABCD' drugs ie adenosine, beta-blockers, calcium-channel blockers, digoxin		**[[Amiodarone]] with 'ABCD' drugs ie [[adenosine]], [[beta-blockers]], [[calcium-channel blockers]], [[digoxin]]
	*Wide-complex, irregular (presumed preexcited A-fib)		*Wide-complex, irregular (presumed preexcited [[A-fib]])
	**Unsynchronized cardioversion (200J)		**Unsynchronized cardioversion (200J)

	===Atrial Fibrillation and Atrial Flutter===		===[[Atrial Fibrillation]] and [[Atrial Flutter]]===
	*Stable		*Stable
	**Procainamide 20-50 mg/min until arrhythmia suppressed		**[[Procainamide]] 20-50 mg/min until arrhythmia suppressed
	**Synchronized cardioversion, 100 - 200 J		**Synchronized [[cardioversion]], 100 - 200 J
	*Unstable - synchronized cardioversion		*Unstable - synchronized cardioversion
	**Consider higher joule dosage and frequency of repeats than for stable		**Consider higher joule dosage and frequency of repeats than for stable
	*Avoid AV nodal blocking agents		*'''Avoid''' AV nodal blocking agents

	==Disposition==		==Disposition==

Rossdonaldson1 at 12:19, 6 April 2019

2019-04-06T12:19:26Z

← Older revision		Revision as of 12:19, 6 April 2019
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	**Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>		**Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>

	===~~Orthodromic Type~~===		===Types by Cycle Direction===
	*Most common variant (~95% of cases)		*Orthodromic
	*~~Accessory pathway (Kent bundles) allows retrograde reentry conduction~~		**Accessory pathway with ''retrograde'' reentry conduction
	*QRS narrow (delta wave absent)		**Most common variant (~95% of cases)
	**Referred to as 'concealed' accessory pathway <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>		**QRS narrow (delta wave absent)
	*May see ST depression, TWI		***Referred to as 'concealed' accessory pathway <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>
	*Rate 150-250 bpm		**May see ST depression, TWI
			**Rate 150-250 bpm
	~~===Antidromic Type===~~		*Antidromic
	*Least common variant (~5% of cases)		**Accessory pathway with ''anterograde'' reentry conduction
	*~~Accessory pathway used for anterograde conduction~~		**Least common variant (~5% of cases)
	*QRS wide, delta wave present		**QRS wide, delta wave present
	*Rate 160-220 bpm, regular		**Rate 160-220 bpm, regular

	===Atrial Fibrillation and Flutter<ref>Burns E. Wolff-Parkinson-White Syndromes. Life in the Fast Lane. http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/.</ref>===		===Atrial Fibrillation and Flutter<ref>Burns E. Wolff-Parkinson-White Syndromes. Life in the Fast Lane. http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/.</ref>===

Rossdonaldson1: /* Types by Aberrant Pathway Site */

2019-04-06T12:16:09Z

Types by Aberrant Pathway Site

← Older revision		Revision as of 12:16, 6 April 2019
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	**Delta wave and QRS complex predominantly negative in V! and V2		**Delta wave and QRS complex predominantly negative in V! and V2
	**Delta wave and QRS complex predominantly positive in other precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>		**Delta wave and QRS complex predominantly positive in other precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>
	*Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>		**Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>

	===Orthodromic Type===		===Orthodromic Type===

Rossdonaldson1 at 12:15, 6 April 2019

2019-04-06T12:15:56Z

← Older revision		Revision as of 12:15, 6 April 2019
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	*Associated with certain genetic predispositions, [[Ebstein anomaly]], and [[hypokalemic periodic paralysis]]<ref>https://rarediseases.org/rare-diseases/wolff-parkinson-white-syndrome/</ref> <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>		*Associated with certain genetic predispositions, [[Ebstein anomaly]], and [[hypokalemic periodic paralysis]]<ref>https://rarediseases.org/rare-diseases/wolff-parkinson-white-syndrome/</ref> <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>

	===~~Type A~~===		===Types by Aberrant Pathway Site===
	*Delta wave and QRS complex predominantly upright in precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>		*Type A
	*Dominant R wave (greater than S amplitude) in V1 may have appearance of right bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>		**Pathway between the ''left'' atrium and ventricle
			**Delta wave and QRS complex predominantly upright in precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>
	~~===~~Type B~~===~~		**Dominant R wave (greater than S amplitude) in V1 may have appearance of right bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>
	*Delta wave and QRS complex predominantly negative in V! and V2		*Type B
	*Delta wave and QRS complex predominantly positive in other precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>		**Pathway between the ''right'' atrium and ventricle
			**Delta wave and QRS complex predominantly negative in V! and V2
			**Delta wave and QRS complex predominantly positive in other precordial leads <ref>https://patient.info/doctor/wolff-parkinson-white-syndrome-pro</ref>
	*Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>		*Appearance of left bundle branch block <ref>https://emedicine.medscape.com/article/159222-workup#c8</ref>

Rossdonaldson1 at 12:07, 6 April 2019

2019-04-06T12:07:31Z

← Older revision		Revision as of 12:07, 6 April 2019
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	==Background==		==Background==
	[[File:WPW.jpeg\|thumb\|Graphic representation of the bundle of Kent in Wolff–Parkinson–White syndrome]]		[[File:WPW.jpeg\|thumb\|Graphic representation of the bundle of Kent in Wolff–Parkinson–White syndrome]]
	~~[[File:DeltaWave09.jpg\|thumb\|Delta wave]]~~
	*Abbreviation: WPW		*Abbreviation: WPW
	*Congenital pre-excitation syndrome		*Congenital pre-excitation syndrome
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
			[[File:DeltaWave09.jpg\|thumb\|Delta wave]]
	*[[ECG]]		*[[ECG]]

Rossdonaldson1: /* Evaluation */

2019-04-06T12:06:32Z

Evaluation

← Older revision		Revision as of 12:06, 6 April 2019
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	*[[ECG]]		*[[ECG]]

	===~~Evaluation~~===		===Diagnosis===
			[[File:WPW09.jpg\|thumb\|12 lead electrocardiogram showing classic findings]]
	''Although the ECG and an electrophysiology study are diagnostic, the characteristic features are not always seen on ECG''		''Although the ECG and an electrophysiology study are diagnostic, the characteristic features are not always seen on ECG''
	*Short PR interval - <0.12sec		*Short PR interval - <0.12sec

Rossdonaldson1: /* Background */

2019-04-06T12:04:41Z

Background

← Older revision		Revision as of 12:04, 6 April 2019
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	==Background==		==Background==
			[[File:WPW.jpeg\|thumb\|Graphic representation of the bundle of Kent in Wolff–Parkinson–White syndrome]]
	[[File:DeltaWave09.jpg\|thumb\|Delta wave]]		[[File:DeltaWave09.jpg\|thumb\|Delta wave]]
	*Abbreviation: WPW		*Abbreviation: WPW