Wolf-Parkinson-White Syndrome

Well I figured I would start the new year with my first official post…. but I don’t think this will be posted until Janurary 2nd(oops). Part of it was due to I was out late for NYE. Maybe some of you the other night had a special some-one as the ball dropped on Dec. 31st. They took the words right out of your mouth. Your heart was palpitating, the champagne made you feel dizzy and you couldn’t catch your breath to speak. Maybe he/she took the words out of your mouth while kissing you, or maybe those symptoms were something more serious. Maybe it was Wolf-Parkinson-White Syndrome!

(Yes this is Meatloaf. Source: Guardian.co.uk)
(Yes this is Meatloaf. Source: Guardian.co.uk)
(Source: Wikipedia.com)

So what is it in a nutshell? An abnormal pathway in the heart between the ventricles and the atria.

What are the symptoms? Dizziness, shortness of breath, palpitations and syncope(fainting). The severity of the syndrome can vary depending on which version you have but can lead to sudden cardiac death.  You don’t have to worry too much as it is only present in 0.1-0.3% of the general population and only 0.6% of cases result in sudden cardiac death. But important to consider if undergoing surgery or taking medication.

How do you diagnose it? Well if you are good at picking up context clues you could probably guess that and ECG is involved by shifting your gaze to the right. That arrow is pointing to what is called a delta wave. It comes after the p wave and before the QRS complex(often described a slurred QRS) during the person’s resting heart rate. When they have symptoms they will likely have atrial fibrillation or atrial flutter on an ECG

(Source: Eli.com)

What gene is it? Well there are likely several, but the most common gene found is the PRKAG2 gene which encodes for a kinase protein the behaves differently. As a result there are 2 main types of WPW Type A and Type B(which have different findings on ECG), but check out the further reading below for that.

So how do you treat it? Well for meds, there is amiodarone(class III anti-arrhythmic) and procainamide(class Ia) which will extinguish the atrial arrhythmia occuring. What’s important is to avoid adenosine(class V), diltiazem(class IV), and verapamil(classIV) when treating a patient who WPW who has atrial fibrillation or atrial flutter. This is because it may lead to uncontrollable ventricular arrhythmias.  Cardioversion is also acceptable but the definitive treatment is cardiac ablation; meaning, going into the heart and and burning this accessory pathway.

So what’s the deal with Meatloaf? Well he was actually diagnosed with WPW. So if you give your heart to the Wolf(-Parkinson-White) with the delta wave, make sure to take the amiodarone, procainamide or ablate it first.

If you want a more comprehensive understanding, read this. For an actual journal publication, read this.