Wolff-Parkinson-White Syndrome (WPW) – The Great Mimicker

The Wolff-Parkinson-White syndrome is an electrocardiographic syndrome which is the expression of an anomalous atrioventricular conduction pathway, congenital in origin. This pathway forms a bypass which enables the supraventricular impulse to bypass the AV node, bundle of His and distal conducting system, and so activate or pre-excite the ventricles.

The anomalous bypass is also known as the Bundle of Kent, is a thin filamentous structure which may be situated ectopically anywhere along the atrioventricular ring – the fibrous junction separating the atria from the ventricles.

Basic ECG presentation of WPW Syndrome

  1. A short PR interval
  2. A slurred, thickened, initial upstroke of the QRS complex, which is termed the delta wave.
  3. A relatively normal – narrow – ensuing terminal QRS deflection. This is sometimes referred to as the main QRS deflection.
  4. Slight widening of the QRS complex as a whole.
  5. Secondary ST segment and T wave changes that is changes which are secondary to the abnormal intraventricular conduction.

Other pathologies mimicked by WPW syndrome

  • Right Ventricular Hypertrophy
  • Posterior Wall MI
  • Anterolateral or Inferior Wall MI
  • Bundle Branch Block
  • Primary Myocardial Disease
  • Ventricular Tachycardia

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