Wolff-Parkinson-White syndrome presenting as atrial fibrillation with broad-QRS complexes

Abstract

The Wolff-Parkinson-White (WPW) syndrome is the commonest form of ventricular pre-excitation and is characterised by the presence of an accessory pathway between atria and ventricles. The term WPW syndrome is applied to patients with both pre-excitation on the ECG and paroxysmal tachycardia. Usually the conducting properties of bypass tracts and the AV node differ, the ventricular response during atrial flutter or fibrillation may be unusually rapid and may cause ventricular fibrillation. Atrial fibrillation (AF) is not an uncommon presentation in emergency department. Moreover, AF associated with WPW syndrome as an underlying condition is also not a rare occurrence; it is seen in 20-25% of WPW Syndrome. Recognition of this condition is very crucial in terms of emergency management. Its early recognition and initial treatment allows rapid restoration to sinus rhythm. Acute management of WPW syndrome with atrial fibrillation with hypotension is DC cardioversion. In haemodynamically stable patients, the drugs of choice are Amiodarone and class Ic anti- arrhythmic agents.

Key words: Paroxysmal tachycardias; pre-excitation; tachycardia.

DOI: 10.3126/jcmsn.v6i3.4078

Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.52-57