Wolff–Parkinson–White (WPW) Syndrome, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Syndrome resulting from the presence of an abnormal (accessory) pathway that bypasses the AV node (Kent bundles) between the atria and ventricles

  • Wolff–Parkinson–White (WPW) pattern o...

Diagnosis

Signs and Symptoms

History

  • Asymptomatic

  • Palpitations:

    • Fast or irregular

  • Chest pain

  • Dyspnea

  • Dizziness

  • Diaphoresis

  • Syncope

  • Sudden death (rare)

Physical Exam

  • Tachycardia:

    • Rapid and regular:

      • Supraventricular ...

Treatment

Pre-Hospital

  • Supplemental oxygen and monitor

  • Vagal maneuvers (Valsalva), carotid massage, and ice water on the face

  • Synchronized cardioversion for:

    • Signs of instability (hypotension, AMS, etc.)

    • A...

Follow-Up

Disposition

Admission Criteria

  • Signs of instability and/or history of syncope

  • Failure of outpatient therapy for continuous pharmacologic control or ablation

Discharge Criteria

  • Most patients will ...

Pearls and Pitfalls

Never use calcium channel blockers, β-blockers, or digoxin in patients with pre-excitation with atrial fibrillation or wide complex tachycardia: 
  • These medications prolong the refra...

Additional Reading

  • Keating  L, Morris  FP, Brady  WJ. Electrocardiographic features of Wolff-Parkinson-White syndrome. Emerg Med J.  2003;20(5):491–493.

  • Mark  DG, Brady  WJ, Pines  JM. Preexcitati...

Codes

ICD9

426.7 Anomalous atrioventricular excitation 

ICD10

I45.6 Pre-excitation syndrome 

SNOMED

  • 74390002 Wolff-Parkinson-White pattern (disorder)

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