Wolff-Parkinson-White syndrome medical therapy

Jump to navigation Jump to search

Wolff-Parkinson-White syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Differentiating Wolff-Parkinson-White syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Approach

History and Symptoms

Electrocardiogram

EKG Examples

Other Diagnostic Studies

Treatment

Risk Stratification

Cardioversion

Medical Therapy

Catheter Ablation

Prophylaxis

Consensus Statement

Case Studies

Case #1

Wolff-Parkinson-White syndrome medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Wolff-Parkinson-White syndrome medical therapy

CDC onWolff-Parkinson-White syndrome medical therapy

Wolff-Parkinson-White syndrome medical therapy in the news

Blogs on Wolff-Parkinson-White syndrome medical therapy

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Wolff-Parkinson-White syndrome medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Rim Halaby, M.D. [3]

Overview

Wolff-Parkinson-White (WPW) syndrome patients who are hemodynamically unstable, as reflected by the presence of hypotension, cold extremities, mottling or peripheral cyanosis, or those who present with ischemic chest pain or decompensated heart failure should urgently undergo direct current cardioversion.[1] The medical therapy of hemodynamically stable patients with WPW syndrome depends on the type of the tachycardia. When the ECG findings suggest orthodromic AVRT, the patient should be managed similarly to patients with supreventricular tachycardia followed by the sequential administration of adenosine, verapamil and procainamide in case of failure to improve. Among patients with antidromic AVRT, AV nodal blocking agents should be avoided and patients should be treated with either procainamide, ibutilide or flecainide.[2] In case of WPW syndrome with atrial fibrillation in hemodynamically stable patients, procainamide, ibutilide or flecainide can be administered.[3] The long term treatment of patients with WPW syndrome depends on the presence or absence of symptoms and their severity. Patients who have poorly tolerated symptomatic WPW syndrome should undergo [[catheter ablation.[2]

Acute Treatment

Atrioventricular Reentrant Tachycardia (AVRT)

  • AVRT is one of the type of tachycardia that can occur in patients with WPW pattern. AVRT can be either orthodromic or antidromic, and the distinction between the two types is important because it dictates the choice of treatment.

Hemodynamically Unstable Patients

  • WPW syndrome patients with AVRT who are hemodynamically unstable, as reflected by the presence of hypotension, cold extremities, mottling or peripheral cyanosis, or those who present with ischemic chest pain or decompensated heart failure should urgently undergo direct current cardioversion. The shocks should be delivered as follows:
    • Narrow regular rhythm: synchronized electrical cardioversion, 50-100 Joules
    • Narrow irregular rhythm: synchronized electrical cardioversion, 120-200 Joules biphasic or 200 Joules monophasic
    • Wide regular rhythm: synchronized electrical cardioversion, 100 Joules
    • Wide irregular rhythm: unsynchronized electrical cardioversion, 200-360 Joules monophasic, or 100-200 Joules biphasic[1]

Orthodromic AVRT in Hemodynamically Stable Patients

Antidromic AVRT in Hemodynamically Stable Patients

Atrial Fibrillation

Hemodynamically Unstable Patients

In hemodynamically unstable patients, urgent direct current cardioversion should be performed.[1]

Hemodynamically Stable Patients

Long Term Treatment

The long term management of patients with WPW syndrome depends on the presence or absence of syndrome. Among symptomatic patients, the tolerability of the symptoms guides the choice of the long term treatment.[2]

Asymptomatic Patients

Symptomatic Patients

References

  1. 1.0 1.1 1.2 "Part 8: Adult Advanced Cardiovascular Life Support". Retrieved 3 April 2014.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 "ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary". Retrieved 15 August 2013.
  3. 3.0 3.1 American College of Cardiology Foundation. American Heart Association. European Society of Cardiology. Heart Rhythm Society. Wann LS, Curtis AB; et al. (2013). "Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines". Circulation. 127 (18): 1916–26. doi:10.1161/CIR.0b013e318290826d. PMID 23545139.

Template:WH Template:WS