Morning Report

Morning Report: WPW

Resident Presenter: Jordan Treworgy PGY-III

Case Summary: A 62 yo male with sudden onset weakness and syncope comes to the ED with rapid heart rate in 220s. History of fainting episodes in past and a “heart condition”. Found to be in narrow complex regular rhythm, but family members state WPW. Patient treated with adenosine and converted.

Learning Points:

  • 3 types of WPW:
    • Orthodromic, antidromic, rapid a-fib
  • Orthodromic form is treated exactly the same as SVT
  • Antidromic form
    • Stable patients may respond to drug therapy including amiodarone, procainamide or ibutilide (remember this is a wide complex tachycardia)
    • Unstable patients may require DC cardioversion
  • Rapid A-fib or a-flutter is treated with procainamide or electricity
    • Treatment w/ nodal blocking agents rapidly conducts the a-fib down the aberrant pathway
    • Up to 20% of patient’s with WPW present this way

EBM Article:

Richard L. Page, José A. Joglar, Mary A. Caldwell. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016;133:e506-e574
Originally published September 23, 2015

References:
1. http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/
2. http://circ.ahajournals.org/content/133/14/e506.full#sec-45 (link to the article)

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