Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White syndrome is due to an accessory pathway connecting the atria and ventricle. Tachydysrhythmias are common. The treatment depends on whether the patient is hemodynamically stable. These patients are at high risk for ventricular fibrillation.



  • Verapamil and diltiazem, calcium channel blockers that depress AV nodal conduction, can worsen WPW.
  • Unstable patients should receive synchronized cardioversion starting at 50 J (monophasic or biphasic).
  • Definitive treatment is ablation.

**ECG Characteristics of Wolff-Parkinson-White:

  • short PR interval, less than 3 small squares (120 ms)
  • slurred delta wave upstroke to the QRS indicating pre-excitation
  • broad QRS
  • secondary ST and T wave changes

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