Wolff–Parkinson–White syndrome: Difference between revisions
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==Disposition== | ==Disposition== | ||
*Admit: | *Discharge: | ||
**Consider if dysrhythmia was easily terminated and can arrange outpt EP study with poss RF catheter ablation | |||
**C/w with cardiologist regarding outpt beta-blockers vs. more potent medications (amiodarone, sotalol, flecainide, etc.) | |||
*Admit or transfer to center with electrophys<ref>Ellis CR et al. Wolff-Parkinson-White Syndrome Treatment & Management. eMedicine. Dec 4, 2015. http://emedicine.medscape.com/article/159222-treatment#showall.</ref>: | |||
**Pts with chest pain, CHF, electrolyte imbalance, or required cardioversion | **Pts with chest pain, CHF, electrolyte imbalance, or required cardioversion | ||
* | **Syncope | ||
** | **Uncertain dx (wide-complex tachycardia) | ||
**Significant associated structural heart disease (MVP, cardiomyopathy) | |||
**Family hx of [[Sudden cardiac death]] | |||
**[[Atrial flutter]] or [[atrial fibrillation]] | |||
==See Also== | ==See Also== | ||
Revision as of 23:38, 26 March 2016
Background
- Suspect in any pt w/ ventricular rate >300
Types
- Orthodromic (~95%)
- Accessory pathway (Kent bundles) is used for retrograde reentry conduction
- QRS narrow (delta wave absent)
- May see ST depression, TWI
- Rate 150-250 bpm
- Accessory pathway (Kent bundles) is used for retrograde reentry conduction
- Antidromic (~5%)
- Accessory pathway used for anterograde conduction
- QRS wide, delta wave present
- Accessory pathway used for anterograde conduction
Diagnosis
- Characteristic features not always seen on ECG
- Short PR interval - <0.12sec
- Due to loss of normal AV node conduction delay
- Differentiate from premature junctional complex
- Delta wave / slurred upstroke
- Due to early activation of ventricular myocardium
- QRS duration > 0.10 sec
- Represents a fusion beat
Treatment
- Orthodromic
- Treat like paroxysmal SVT:
- Unstable
- Cardioversion (synchronized)
- Adult: 50-100 J
- Peds: 0.5-2 J/kg
- Cardioversion (synchronized)
- Stable
- CCBs, BBs, procainamide, or adenosine
- Procainamide safe irrespective of type of pathway conduction
- CCBs, BBs, procainamide, or adenosine
- Unstable
- Treat like paroxysmal SVT:
- Antidromic
- Treat like ventricular tachycardia:
- Synchronized cardioversion
- Adult: 50-100 J
- Peds: 0.5-2 J/kg
- Procainamide
- 17mg/kg IV over 30min (up to 50mg/kg or 50% widening of QRS complex)
- Amiodarone
- Contraindicated: 'ABCD' drugs ie adenosine, BBs, CCBs, digoxin
- Synchronized cardioversion
- Treat like ventricular tachycardia:
- Wide-complex, irregular (presumed preexcited A-fib)
- Unsynchronized cardioversion (200J)
Disposition
- Discharge:
- Consider if dysrhythmia was easily terminated and can arrange outpt EP study with poss RF catheter ablation
- C/w with cardiologist regarding outpt beta-blockers vs. more potent medications (amiodarone, sotalol, flecainide, etc.)
- Admit or transfer to center with electrophys[1]:
- Pts with chest pain, CHF, electrolyte imbalance, or required cardioversion
- Syncope
- Uncertain dx (wide-complex tachycardia)
- Significant associated structural heart disease (MVP, cardiomyopathy)
- Family hx of Sudden cardiac death
- Atrial flutter or atrial fibrillation
See Also
- ↑ Ellis CR et al. Wolff-Parkinson-White Syndrome Treatment & Management. eMedicine. Dec 4, 2015. http://emedicine.medscape.com/article/159222-treatment#showall.