Wolff-Parkinson-White syndrome diagnosis overview: Difference between revisions
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{{Wolff-Parkinson-White syndrome}} | {{Wolff-Parkinson-White syndrome}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{Sara.Zand}} {{CZ}} | ||
==Overview== | ==Overview== | ||
The diagnose of [[WPW]] pattern is commonly made by an incidental [[electrocardiogram|ECG]] finding in an [[asymptomatic]] individuals. The characteristic [[EKG]] finding is a [[delta wave]], which represents the pre-excitation of the [[ventricles]] through the [[accessory pathway]]. This phenomenon presents because the [[AV node]] has the property of slowing the impulses, therefore the conduction through the [[accessory pathway]] is faster, therefore the [[ventricles]] are excited through two different pathways. The [[delta wave]] is an upstroke in the [[R wave]] of the [[QRS]] complex that is associated with a short [[PR interval]]. [[Delta waves]] are only present when the patient is in sinus rhythm, when[[ tachycardia]] starts the [[delta wave]] is no longer present. Patients [[WPW]] syndrome with episodes of [[atrial fibrillation]] will present [[ECG ]] with rapid irregular [[wide-complex tachycardia]]. The combination of [[atrial fibrillation]] and [[WPW]] may increase the risk of very rapid [[antidromic AVRT]] and occurrence of [[ventricular fibrillation]]. [[AV node]] blocking agents are contraindicated in these patients because it will enhance the conduction through the [[accessory pathway]]. Patients with [[WPW]] may exhibit more than one [[accessory pathway]] which is common in patients with [[Ebstein's anomaly]]. | |||
==Wolff-Parkinson-White syndrome diagnosis== | |||
* The diagnose of [[WPW]] pattern is commonly made by an incidental [[electrocardiogram|ECG]] finding in an [[asymptomatic]] individuals. | * The diagnose of [[WPW]] pattern is commonly made by an incidental [[electrocardiogram|ECG]] finding in an [[asymptomatic]] individuals. | ||
* The characteristic [[EKG]] finding is a [[delta wave]], which represents the pre-excitation of the [[ventricles]] through the [[accessory pathway]] | * The characteristic [[EKG]] finding is a [[delta wave]], which represents the pre-excitation of the [[ventricles]] through the [[accessory pathway]] | ||
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* [[Delta waves]] are only present when the patient is in sinus rhythm, when[[ tachycardia]] starts the [[delta wave]] is no longer present. | * [[Delta waves]] are only present when the patient is in sinus rhythm, when[[ tachycardia]] starts the [[delta wave]] is no longer present. | ||
* Patients [[WPW]] syndrome with episodes of [[atrial fibrillation]] will present [[ECG ]] with rapid irregular [[wide-complex tachycardia]].<ref name="Fengler-2007">{{Cite journal | last1 = Fengler | first1 = BT. | last2 = Brady | first2 = WJ. | last3 = Plautz | first3 = CU. | title = Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED. | journal = Am J Emerg Med | volume = 25 | issue = 5 | pages = 576-83 | month = Jun | year = 2007 | doi = 10.1016/j.ajem.2006.10.017 | PMID = 17543664 }}</ref> | * Patients [[WPW]] syndrome with episodes of [[atrial fibrillation]] will present [[ECG ]] with rapid irregular [[wide-complex tachycardia]].<ref name="Fengler-2007">{{Cite journal | last1 = Fengler | first1 = BT. | last2 = Brady | first2 = WJ. | last3 = Plautz | first3 = CU. | title = Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED. | journal = Am J Emerg Med | volume = 25 | issue = 5 | pages = 576-83 | month = Jun | year = 2007 | doi = 10.1016/j.ajem.2006.10.017 | PMID = 17543664 }}</ref> | ||
* The combination of [[atrial fibrillation]] and [[WPW]]increase the risk of very rapid [[antidromic AVRT]] and occurrence of [[ventricular fibrillation]]. | * The combination of [[atrial fibrillation]] and [[WPW]] may increase the risk of very rapid [[antidromic AVRT]] and occurrence of [[ventricular fibrillation]]. | ||
* [[AV node]] blocking agents are contraindicated in these patients because it will enhance the conduction through the [[accessory pathway]]. | * [[AV node]] blocking agents are contraindicated in these patients because it will enhance the conduction through the [[accessory pathway]]. | ||
* Patients with [[WPW]] may exhibit more than one [[accessory pathway]] which is common in patientds with [[Ebstein's anomaly]].<ref name="europace.oxfordjournals.org">{{Cite web | last = | first = | title = Radiofrequency ablation of multiple accessory pathways | url = http://europace.oxfordjournals.org/content/4/3/273 | publisher = | date = | accessdate = 14 April 2014 }}</ref> | * Patients with [[WPW]] may exhibit more than one [[accessory pathway]] which is common in patientds with [[Ebstein's anomaly]].<ref name="europace.oxfordjournals.org">{{Cite web | last = | first = | title = Radiofrequency ablation of multiple accessory pathways | url = http://europace.oxfordjournals.org/content/4/3/273 | publisher = | date = | accessdate = 14 April 2014 }}</ref> | ||
* The most common combination of accessory pathways in [[Ebstein]] anomaly was the right posteroseptal and right free wall pathway. | |||
* [[Wolff-Parkinson-White syndrome]] is sometimes associated with [[Leber's hereditary optic neuropathy]] (LHON), a form of [[mitochondrial disease]].<ref name="Nikoskelainen-1994">{{Cite journal | last1 = Nikoskelainen | first1 = EK. | last2 = Savontaus | first2 = ML. | last3 = Huoponen | first3 = K. | last4 = Antila | first4 = K. | last5 = Hartiala | first5 = J. | title = Pre-excitation syndrome in Leber's hereditary optic neuropathy. | journal = Lancet | volume = 344 | issue = 8926 | pages = 857-8 | month = Sep | year = 1994 | doi = | PMID = 7916404 }}</ref><ref name =Mashima_et_al_1996> | * [[Wolff-Parkinson-White syndrome]] is sometimes associated with [[Leber's hereditary optic neuropathy]] (LHON), a form of [[mitochondrial disease]].<ref name="Nikoskelainen-1994">{{Cite journal | last1 = Nikoskelainen | first1 = EK. | last2 = Savontaus | first2 = ML. | last3 = Huoponen | first3 = K. | last4 = Antila | first4 = K. | last5 = Hartiala | first5 = J. | title = Pre-excitation syndrome in Leber's hereditary optic neuropathy. | journal = Lancet | volume = 344 | issue = 8926 | pages = 857-8 | month = Sep | year = 1994 | doi = | PMID = 7916404 }}</ref><ref name =Mashima_et_al_1996> | ||
{{cite journal | {{cite journal | ||
Latest revision as of 20:31, 9 November 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]
Overview
The diagnose of WPW pattern is commonly made by an incidental ECG finding in an asymptomatic individuals. The characteristic EKG finding is a delta wave, which represents the pre-excitation of the ventricles through the accessory pathway. This phenomenon presents because the AV node has the property of slowing the impulses, therefore the conduction through the accessory pathway is faster, therefore the ventricles are excited through two different pathways. The delta wave is an upstroke in the R wave of the QRS complex that is associated with a short PR interval. Delta waves are only present when the patient is in sinus rhythm, whentachycardia starts the delta wave is no longer present. Patients WPW syndrome with episodes of atrial fibrillation will present ECG with rapid irregular wide-complex tachycardia. The combination of atrial fibrillation and WPW may increase the risk of very rapid antidromic AVRT and occurrence of ventricular fibrillation. AV node blocking agents are contraindicated in these patients because it will enhance the conduction through the accessory pathway. Patients with WPW may exhibit more than one accessory pathway which is common in patients with Ebstein's anomaly.
Wolff-Parkinson-White syndrome diagnosis
- The diagnose of WPW pattern is commonly made by an incidental ECG finding in an asymptomatic individuals.
- The characteristic EKG finding is a delta wave, which represents the pre-excitation of the ventricles through the accessory pathway
- This phenomenon presents because the AV node has the property of slowing the impulses, therefore the the conduction throuhg the accessory pathway is faster, therefore the ventricles are excited through two different pathways.[1]
- The delta wave is an upstroke in the R wave of the QRS complex that is associated with a short PR interval.
- Delta waves are only present when the patient is in sinus rhythm, whentachycardia starts the delta wave is no longer present.
- Patients WPW syndrome with episodes of atrial fibrillation will present ECG with rapid irregular wide-complex tachycardia.[2]
- The combination of atrial fibrillation and WPW may increase the risk of very rapid antidromic AVRT and occurrence of ventricular fibrillation.
- AV node blocking agents are contraindicated in these patients because it will enhance the conduction through the accessory pathway.
- Patients with WPW may exhibit more than one accessory pathway which is common in patientds with Ebstein's anomaly.[3]
- The most common combination of accessory pathways in Ebstein anomaly was the right posteroseptal and right free wall pathway.
- Wolff-Parkinson-White syndrome is sometimes associated with Leber's hereditary optic neuropathy (LHON), a form of mitochondrial disease.[4][5]
-
One beat from a rhythm strip in V2 demonstrating characteristic findings in WPW syndrome. Note the characteristic delta wave (subtler here than in some cases), the short PR interval of 0.08 seconds, and the long QRS complex at 0.12 seconds.
References
- ↑ Sethi, KK.; Dhall, A.; Chadha, DS.; Garg, S.; Malani, SK.; Mathew, OP. (2007). "WPW and preexcitation syndromes". J Assoc Physicians India. 55 Suppl: 10–5. PMID 18368860. Unknown parameter
|month=ignored (help) - ↑ Fengler, BT.; Brady, WJ.; Plautz, CU. (2007). "Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED". Am J Emerg Med. 25 (5): 576–83. doi:10.1016/j.ajem.2006.10.017. PMID 17543664. Unknown parameter
|month=ignored (help) - ↑ "Radiofrequency ablation of multiple accessory pathways". Retrieved 14 April 2014.
- ↑ Nikoskelainen, EK.; Savontaus, ML.; Huoponen, K.; Antila, K.; Hartiala, J. (1994). "Pre-excitation syndrome in Leber's hereditary optic neuropathy". Lancet. 344 (8926): 857–8. PMID 7916404. Unknown parameter
|month=ignored (help) - ↑ Mashima Y, Kigasawa K, Hasegawa H, Tani M, Oguchi Y. (1996). "High incidence of pre-excitation syndrome in Japanese families with Leber's hereditary optic neuropathy" (subscription required). Clinical Genetics. 50 (6): 535–7. PMID 9147893.