Wolff Parkinson White (WPW) syndrome

- syndrome of pre-excitation of ventricles due to Bundle of Kent (accessory pathway)
- Type A WPW (posterior left atrial wall to left ventricle), negative delta wave in lead I and positive delta wave in leads V1-V6
- Type B WPW (lateral right atrial wall to right ventricle), positive delta wave in lead I and biphasic or negative delta wave in leads V1-V3
- common types of arrhythmias at presentation: reciprocating tachycardia (80%), atrial fibrillation(15%), atrial flutter (5%)
- associations : Hypertrophic cardiomyopathy (HCM), Ebstein's anomaly, mitral valve prolapse, thyrotoxicosis, Leber's hereditary optic neuropathy (LHON)
- ECG: delta wave
- can be associated with negative delta waves in II, III, aVF
- definite treatment : radiofrequency catheter ablation of accessory pathway
- Drugs to be avoided in WPW (ABCD)

• A - adenosine
• B - beta blocker
• C - calcium channel blocker
• D - digoxin

- treatment for WPW with AF : flecainide, sotalol, disopyramide, amiodarone
- Short PR interval without delta wave suggest Lown Ganong Levine (LGL) syndrome