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HWN Suggests

Wolff-Parkinson Wait!

It is imperative to recognize AF with WPW, as incorrect treatment with AV nodal blocking agents can be fatal. Blocking the AV node in these patients will result in preferential use of the accessory pathway. Rates may exceed 300 or 400 bpm and are at extreme risk for degeneration into ventricular fibrillation (VF). Thus, an irregular wide complex tachycardia with rates approaching 300 bpm, bizarre and varying QRS morphologies, and a stable axis, must be treated as AF with WPW until proven otherwise. Procainamide (50-100 mg every 2 min to a max dose of 17 mg/kg) or ibutilide (0.01 mg/kg maximum 1 mg over 10 min) are the treatments of choice for chemical conversion.4 Amiodarone is controversial…

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  Back to Basics: Wolff-Parkinson-White (WPW)

Narrow complex: Treat similar to SVT Wide complex: treat with procainamide or cardioversion.

 Afib with WPW

Treatment: · DO NOT give: adenosine, verapamil, diltiazem, digoxin, beta blocker or amio. Due to the presence of accessory pathway blocking down the AV node, may cause the accessory pathway to become the primary driver of conduction. · Treated with IV procainamide if clinically stable. Dose is 15-16 mg/kg given at a rate no faster than 50 mg/min. · If unstable: Immediate DC cardioversion

 Sirens to Scrubs: Wolff-Parkinson-White Syndrome

As you begin to coach her through vagal maneuvers and reach for your adenosine she advises you ‘I have something called Wolff-Parkinson-White – does that change anything?’ You think maybe it does, but you’re not sure...

 Why rapid recognition, treatment of Wolff-Parkinson-White syndrome is important

Wolff-Parkinson-White syndrome is a relatively uncommon congenital heart defect. A large percentage of WPW patients will present a tachyarrythmia. Of this subgroup of patients, 20 percent will have atrial fibrillation. Atrial fibrillation in WPW is particularly dangerous because the normal rate-limiting function of the AV node is bypassed with an accessory tract.

Articles of Interest

Ablation and the Road to recovery

I can recall a few moments during the procedure where I was aware beeping and alarms. My heartbeat fluttered on occasion. I believe they had triggered palpitations as part of the process.

AFib in Wolff-Parkinson-White Syndrome

Treatment with AV nodal blocking drugs e.g. adenosine, calcium-channel blockers, beta-blockers may increase conduction via the accessory pathway with a resultant increase in ventricular rate and possible degeneration into VT or VF.

Atrial Fibrillation in WPW Syndrome – Pearls and Pitfalls

AF in WPW – it looks similar to polymorphic VT but lacks the undulating baseline seen in torsades de pointes.

Current strategy for treatment of patients with Wolff–Parkinson–White syndrome...

The aims of this survey was to provide insight into treatment activity, the strategy of treatment, and risk stratification of patients with asymptomatic and symptomatic ventricular pre-excitation across Europe. Fifty-eight centres, members of the European Heart Rhythm Association EP research network, covering 20 countries answered the survey questions.

ECG Pointers: Syncope and Wolff-Parkinson-White

Cardiac Rhythms associated with WPW: Sinus Rhythm, Reentrant Paroxysmal SVT (80% of arrhythmias in WPW), Antidromic AVRT: Impulses travel anterograde down the AP and retrograde through the AV node. Rare, occurs in less than 5% of patients with WPW, Atrial fibrillation with WPW (a subset of orthodromic AVRT): 20% to 30% of patients with WPW will also have atrial fibrillation.

Hide and Seek: Intermittent Preexcitation Wolff-Parkinson-White Syndrome Case Report and Management Overview

A myriad of other tachyarrhythmias may occur in WPW syndrome. Far less common than orthodromic AVRT, antidromic AVRT may also occur at an incidence of 5% of WPW patients. Procainamide, a class 1A antiarrhythmic medication that acts by inhibiting cardiac myocyte sodium channels, is an appropriate medical treatment option in otherwise stable antidromic AVRT patients, though electrical cardioversion stands as another reasonable treatment option. Rarely, WPW may lead to sudden cardiac death (SCD) due to atrial fibrillation and subsequent ventricular tachycardia and ventricular fibrillation,

Pediatric WPW

EKG shows a wide complex tachycardia rhythm. If team gives AV nodal blocking agents, the pt will devolve into a VF rhythm, and the pt will become nonresponsive. If team administers procainamide, pt will go into a rate controlled rhythm that reveals WPW and should then be placed on a procainamide drip.

Safe practice in SVT with WPW

Orthodromic SVT in WPW can be treated much like any other SVT (adenosine, vagal manoeuvres etc), whereas in antidromic SVT many of the usual drugs are contraindicated. AF is disturbingly common in WPW- 10 to 30% of patients will have it at some point.

Tachydysrhythmias with Amal Mattu and Paul Dorion

Atrial fibrillation with Wolff Parkinson White (WPW) Irregularly irregular tachycardia Changing QRS morphologies (as opposed to AF with a bundle branch block, which will be monomorphic) Rate 250-300 bpm

Treating WPW Syndrome

Wide complex tachycardia in WPW must be treated with procainamide or electrical cardioversion and AV nodal blockade avoided. This is because the pathway is probably going retrograde through the AV node (antidromic rhythm creates wide complex) and blocking the AV node could send the pathway to a completely unchecked alternative route around it.