Wolff–Parkinson–White syndrome: Difference between revisions

Revision as of 20:56, 9 April 2011

Background

Orthodromic
- Accessory pathway used for retrograde reentry conduction
  - QRS narrow, delta wave absent
  - May see ST depression, TWI
  - Rate 150-250 bpm
Antidromic
- Accessory pathway used for anterograde conduction
  - QRS wide, delta wave present

Atrial fibrillation seen in 10-30%

Diagnosis

Characteristic features not always seen on ECG

Short PR interval - <0.12sec
1. Due to loss of normal AV node conduction delay
Delta wave / slurred upstroke
1. Due to early activation of vent myocardium
QRS duration > 0.10 sec
1. Due to delta wave

DDX

idiopathic
hypertrophic cardiomyopathy
transposition of great vesses
endocardial fibroelastosis
mitral valve prolapse
tricuspid atresia
ebstein disease

Treatment

Orthodromic
- Treat like paroxysmal SVT
  - CCBs, BBs, procainamide, or adenosine
  - Procainamide safe irrespective of type of pathway conduction
  - Cardiovert (sync) if unstable
  - Adult: 50-100 J
  - Peds: 0.5- 2 J/kg

Antidromic
Procainamide 100mg q10min until disrhythmia terminated or max dose (1000mg)
- Amiodarone
- Cardioversion
  - Adult: 50-100 J
  - Peds: 0.5- 2 J/kg
- Contraindicated: CCBs, BBs, digoxin, adenosine

Irregular tachycardia
- Treat like antidromic

Disposition

Admission:
- Cardioverted, chest pain, CHF, or electrolyte imbalance
Discharge
- If easily terminated d/c w/ outpt EP study

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-usually 150- 300 bpm
+*Orthodromic
+**Accessory pathway used for retrograde reentry conduction
+***QRS narrow, delta wave absent
+***May see ST depression, TWI
+***Rate 150-250 bpm
+*Antidromic
+**Accessory pathway used for anterograde conduction
+***QRS wide, delta wave present
+*Atrial fibrillation seen in 10-30%
 ==Diagnosis==
-#short PR interval <0.12 sec
+*Characteristic features not always seen on ECG
-#QRS duration >0.10 sec
-#delta wave/ slurred upstroke
-#short PR interval due to loss of normal AV node conduction delay
-#delta wave due to early activation of vent myocardium
-===Orthodromic Tachycrd===
-#the accessory path used for retrograde reentry conduction and AV node used for anterograde conduction. QRS is narrow, delta wave absent
-#TX with CA channel blockers, beta blockers, procainamide, adenosine.
-#Cardiovert (sync) if unstable with 50- 100J (0.5- 2J/kg for kids)
-===Antidromic Tachycrd===
+#Short PR interval - <0.12sec
-#access path used for anterograde conduction and AV node used for retrograde reentry.
+##Due to loss of normal AV node conduction delay
-#do not use beta blckrs of ca chnnl blckrs since will block down AV node only and not acc path and will actually speed up arrhythmia.
+#Delta wave / slurred upstroke
-#TX with procainamide- 100mg q10 min until arrhrythmia terminated or max dose of 1000mg given. If no success, then cardiovert.
+##Due to early activation of vent myocardium
-#Cardiovert (sync) if unstable with 50- 100J (0.5- 2J/kg for kids)
+#QRS duration > 0.10 sec
+##Due to delta wave
 ==DDX==
@@ Line 28: / Line 29: @@
 #tricuspid atresia
 #ebstein disease
+==Treatment==
+*Orthodromic
+**Treat like paroxysmal SVT
+***CCBs, BBs, procainamide, or adenosine
+***Procainamide safe irrespective of type of pathway conduction
+***Cardiovert (sync) if unstable
+***Adult: 50-100 J
+***Peds: 0.5- 2 J/kg
+*Antidromic
+*Procainamide 100mg q10min until disrhythmia terminated or max dose (1000mg)
+**Amiodarone
+**Cardioversion
+***Adult: 50-100 J
+***Peds: 0.5- 2 J/kg
+**Contraindicated: CCBs, BBs, digoxin, adenosine
+*Irregular tachycardia
+**Treat like antidromic
 ==Disposition==
-Admission:
+*Admission:
-#admit if cardioverted, chest pain, CHF, electrolyte imbalance.
+**Cardioverted, chest pain, CHF, or electrolyte imbalance
-#if easily terminated can be discharged with outpt electrophysiological study
+*Discharge
+**If easily terminated d/c w/ outpt EP study
 [[Category:Cards]]