Rapid Review: Wolff-Parkinson-White (WPW) Syndrome

Reviewed January 2024

Wolff-Parkinson-White (WPW) Syndrome

• ECG will show short PR interval, delta wave, wide QRS
• Most commonly caused by an accessory pathway (bundle of Kent) connecting atria to ventricles, bypassing AV node
• Acute treatment:
  • Orthodromic (narrow complex): vagal maneuvers, AV nodal blockers (adenosine, beta-blocker, calcium channel blocker)
  • Antidromic (wide complex): procainamide
  • Synchronized cardioversion for hemodynamically unstable patients
• Definitive treatment is radiofrequency ablation

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Sample question:

A 23-year-old man presents to your clinic with intermittent episodes of chest discomfort, heart palpitations, and decreased exercise tolerance. Which of the following ECG findings would most strongly suggest a diagnosis of Wolff-Parkinson-White syndrome?