Wolff-Parkinson-White syndrome diagnosis overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

The diagnose of WPW pattern is commonly made by an incidental ECG finding in an asymptomatic individual. 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 rythm, when tachycardia starts the delta wave is no longer pressent.

Patients WPW syndrome with episodes of atrial fibrillation will present ECG with rapid polymorphic wide-complex tachycardia.[2] This combination of atrial fibrillation and WPW is considered dangerous as a high risk of ventricular fibrillation is present. AV node blocking agents are contraindicated in this patients because it will enhance the conduction through the accessory pathway.

Patients with WPW can exhibit more than one accessory pathway, this condition is more common in patientds with Ebstein's anomaly.[3]

Wolff-Parkinson-White syndrome is sometimes associated with Leber's hereditary optic neuropathy (LHON), a form of mitochondrial disease. The presence of pre-excitation syndromes in patients with LHON disease has been associated with the mutation in the 11778 mitochondrial DNA mutation.[4][5]

References

  1. 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)
  2. 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)
  3. "Radiofrequency ablation of multiple accessory pathways". Retrieved 14 April 2014.
  4. 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)
  5. 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.



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