ECG: WPW Syndrome
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ECG: WPW Syndrome ECG: WPW Syndrome Presentation Transcript

  • PROF .Dr G.SUNDARAMURTY ‘S UNIT M6 S.DHANRAJ Ist YEAR PG
  • HISTORY
    • A 45 YR old female presented with
      • Difficulty in breathing
      • Palpitation
      • Sweating
        • for past 4 hours
  • ECG
  • FINDINGS
    • Normal sinus rhythm
    • Rate 80 / min
    • Axis normal
    • PR shortened 0.08 sec
    • Broad QRS complex
    • QRS duration 0.12 sec
    • QTC 0.40 sec
    • Delta wave noticed(slurred QRS upstroke)
    • Terminal QRS normal
    • Secondary ST/T changes seen
  • DIAGNOSIS
    • WPW SYNDROME
      • POSSIBLE PATHWAYS
        • Right posteroseptal
        • anteroseptal
  • PATHWAYS
  • HISTORY
    • Named after three scientists
      • WOLFF
      • PARKINSON
      • WHITE
        • In the year 1930
  • DEFINITION
    • WPW is a electrocardiographic syndrome it is the expression of anomalous atrio ventricular conduction pathway congenital in origin
    • This pathway forms a bypass which enables supraventricular impulse to bypass AV node , bundle of HIS and distal conducting system and so activate or pre exite the ventricles
    • This anomalous bypass, most commonly bundle of kent situated any where along AV node
  • ECG PRESENTATION
    • Short PR interval
    • Slurred initial upstroke of QRS – delta wave
    • Relatively normal , narrow terminal QRS –main QRS deflection
    • Slight widening of QRS
    • Secondary STT changes
  • CARDIAC ACTIVATION
    • PHASE 1
      • Atrial activation- normal
      • PHASE 2:
      • Ventricular pre-exitation
      • sinus activation occurs through both normal , anomalous pathway
      • anomalous pathway lacks AV nodal conduction delay
      • so sinus impulse conducted at a rapid rate
      • this enables ventricles to be activated or pre exited- short PR interval , delta wave
      • Further activation through normal pathway
      • PHASE 3:
      • Narrow terminal QRS
  •  
  • OLD CLASSIFICATION
    • Type A
    • In this type of WPW syndrome, the delta wave and QRS complex are predominantly upright in the precordial leads. The dominant R wave in lead V1 may be misinterpreted as right bundle branch block.
    • Type B
    • The delta wave and QRS complex are predominantly negative in leads V1 and V2 and positive in the other precordial leads, resembling left bundle branch block.
  • PATHWAY
  •  
  • ORTHODROMIC
    • DESCEND- NORMAL PATHWAY
    • ASCEND- ACCESSORY PATHWAY
    • In orthodromic tachycardia, the normal pathway is used for ventricular depolarization and the accessory tract is used for reentry.
    • VPC’s can initiate orthodromic tachycardia
    • On ECG findings,
      • the delta wave is absent,
      • QRS complex is normal,
      • P waves are inverted in the inferior and lateral leads
  •  
  • ANTIDROMIC
    • LESS COMMON PATHWAY.
    • DESCEND- ACCESSORY PATHWAY.
    • ASCEND – NORMAL PATHWAY
    • On ECG findings,
      • the QRS is wide, which is an exaggeration of the delta wave during sinus rhythm (ie, wide-QRS tachycardia).
      • Such tachycardias are difficult to differentiate from ventricular tachycardia
  •  
  •  
  • PATHWAYS
  • FIBRES
    • KENT PATHWAY : ATRIO-VENTRICULAR
    • JAMES PATHWAY : ATRIO-HIS
    • MAHAIM PATHWAY: HISO- VENTRICULAR
    • MAHAIM FIBRE:
    • Orgin- distal to AV node
    • Ends in the venricular myocardium
    • ECG :
    • normal PR interval
    • delta waves
    • JAMES FIBRE
    • (LGL SYNDROME)
    • Origin- atria
    • Bypass AV node
    • Ends in bundle of HIS
    • ECG :
    • Short PR
    • Normal QRS
  •  
  • COMPLICATION
    • Tachyarrhythmia
    • Syncopal attacks
    • Sudden cardiac death
    • Complications of drug therapy (eg, proarrhythmia, organ toxicity)
    • Complications associated with invasive procedures and surgery
    • Recurrence
  • TREATMENT
    • ANTIARRYTHMICS– class 1c, 3
    • RADIOFREQUENCY ABLATION ( TOC)
    • SURGICAL ABLATION ( OUTDATED)
  • CAUTION
    • Usual presentation is SVT
    • Sudden cadiac death possible
    • Digoxin, beta blockers,verapamil are contraindicated
    • Underlying Ebstein’s anomaly, hypertrophic cardiomyopathy should be evaluated
  • THANK YOU