Prevalence
Epidemiology of the Wolff-Parkinson-White pattern and syndrome.
population
Men: Women
Pattern vs. Syndrome
He pattern WPW are ECG findings without symptoms (silent accessory pathway). He syndrome WPW is the presence of the electrocardiographic pattern accompanied by symptomatic tachyarrhythmias.
Presentation Peak
Although it is congenital, it usually manifests in the childhood and adolescence. Up to 20-30% of children diagnosed in infancy may lose conduction through the accessory pathway spontaneously as they grow older.
Clinical Presentation
Signs in Infants
Infants cannot report palpitations. Diagnosis in the emergency room requires high clinical suspicion in the face of non-specific symptoms.
- Extreme irritability or lethargy
- Feeding refusal / Poor suction
- Paleness or cyanosis
- Tachypnea and heart failure
- HR is usually > 220-250 bpm
Older Children and Adolescents
ECG (Sinus Rhythm) Criteria
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Management in Emergencies
Hemodynamic Instability?
Hypotension, sensory disturbance, shock, severe heart failure.
Stable Patient (SVT - TRIN or Orthodromic)
Vagal Maneuvers
Infants: Ice on the face (immersion reflex) for 10-15 seconds.
Older children: Modified Valsalva maneuver, blowing through a straw or syringe.
Pharmacological Treatment
Initial dose: 0.1 mg/kg (max 6 mg).
Second dose: 0.2 mg/kg (max 12 mg).
Always follow with SSF quick wash.
Absolute Contraindications
If the patient presents Pre-excited Atrial Fibrillation (irregular wide QRS tachycardia), blocking the AV node is lethal. All conduction will pass through the accessory pathway, degenerating into Ventricular Fibrillation.
Avoid the "ABCD" rule:
- Adenosine
- Beta-blockers
- Calkyoantagonists
- DIgoxin / Diltiazem
Management in pre-excited AF: Procainamide, Amiodarone or Electrical Cardioversion.