EASY WAY TO REMEMBER: WPW SYNDROME

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 WOLFF-PARKINSON-WHITE SYNDROME (WPW) BASICS



SIMPLE CONCEPT: PR-INTERVAL (SHORT).

                                   DELTA WAVE.

                                   QRS COMPLEX (LONG)

OVERVIEW:

THE ONLY NORMAL ELECTRICAL CONNECTION BETWEEN THE ATRIA AND VENTRICLES IS THE HIS BUNDLE .

SOME PEOPLE, HOWEVER, HAVE AN EXTRA (OR) "ACCESSORY" CONDUCTING BUNDLE, A CONDITION KNOWN AS THE WPW SYNDROME.

THE ACCESSORY BUNDLES FORM A DIRECT CONNECTION BETWEEN THE ATRIUM AND THE VENTRICLE, USUALLY ON THE LEFT SIDE OF THE HEART, AND IN THESE BUNDLES THERE IS NO (AV-NODE) TO DELAY CONDUCTION.

A DEPOLARIZATION WAVE THEREFORE  REACHES THE VENTRICLE EARLY AND PRE-EXCITATION OCCURS.

PR-INTERVAL SHORT, AND THE QRS COMPLEX SHOWS AN EARLY SLURRED UPSTROKE CALLED A "DELTA WAVE".

THE SECOND PART OF QRS IS NORMAL, AS CONDUCTION THROUGH THE HIS BUNDLE CATCHES UP WITH THE PRE-EXCITATION.



NOTE: SINUS RHYTHM, RIGHT AXIS DEVIATION, SHORT PR-INTERVAL.

             SLURRED UPSTROKE OF THE QRS COMPLEX, BEST SEEN IN LEADS V3 AND V4, WIDE QRS COMPLEX DUE TO THIS 'DELTA' WAVE. 

             DOMINANT R-WAVE IN LEAD V1.

THERE ARE 2 TYPES OF WPW: [TYPE A] AND [TYPE B]

1) TYPE A - THE PATHWAY IS LEFT-SIDED, CONNECTING THE LEFT ATRIUM AND LEFT VENTRICLE, AND CAUSES A DOMINANT R-WAVE IN LEAD V1.

2) TYPE B - THE ABNORMAL PATHWAY CAN BE RIGHT-SIDED CONNECTING RIGHT ATRIUM AND RIGHT VENTRICLE.

THE WIDE QRS COMPLEX SEEN IN BOTH TYPES OF WPW SYNDROME.

             

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