Wolff-Parkinson-White syndrome in infants

Wolff-Parkinson-White (WPW) syndrome is a ventricular preexcitation that presents as supraventricular tachycardia. Health care professionals can attain optimal results in caring for infants with WPW syndrome by understanding both its pathophysiology and proper management to prevent and treat complications associated with it. This article reviews the prevalence, pathophysiology, clinical manifestations, diagnostic modalities, assessment, and management of WPW syndrome.

Wolff Parkinson White (WPW) syndrome: what the critical care nurse needs to consider when administering antiarrhythmics

This paper discusses the importance of critical care and emergency nurses having an understanding of why pre-existing cardiac disorders can influence antiarrhythmic treatment. The patient with a pre-excitation syndrome is usually managed in a coronary care unit. However, these patients may be admitted to an intensive care unit (ICU) with complications of Wolff Parkinson White (WPW) syndrome; for example post cardiopulmonary arrest or WPW as a co-morbidity. It is common practice in critical care areas for registered nurses to administer antiarrhythmics without a doctor's prescription in life-threatening situations. Therefore, the critical care nurse must have knowledge of the implications of administering standard antiarrhythmic agents if this patient reverts into a tachyarrhythmia. If antiarrhythmics are administered that are contraindicated in patients with WPW syndrome, then there is potential for deleterious effects. This case study highlights the different pharmacological agents for treating tachyarrhythmias in a patient with WPW syndrome. The paper outlines the correct treatment and discusses the deleterious effects of incorrect administration of drugs in WPW syndrome.

Medically complex pregnancy: a case report illustrating CNM/MD collaborative management

In contemporary society, many women with complex medical conditions are attempting fertility and becoming pregnant. The patient presents with an impressive medical complication, yet many of her key educational and psychosocial needs are typical of those for any pregnant woman. Striving for "normalcy," she may actively seek midwifery care to help her create a family-centered birth experience. Indeed, the midwife practicing with physician colleagues may have the opportunity to collaboratively manage increasingly complex cases. This article describes the case of collaborative management during pregnancy and delivery of a patient with the cardiac syndrome Wolff-Parkinson White syndrome (WPW). First diagnosed with WPW at the age of 13, the patient's condition was initially controlled with oral medication. Eventually, the patient's symptomology worsened and required repeated treatment by cardiac ablation of the accessory pathway. Illustrative of the possibilities for enhanced care of the medically complex pregnant patient via collaborative management, the discussion details not only the pertinent physiologic events but the benefits and process of care. A review of the cardiophysiology of WPW is also presented.

Nursing grand rounds: Wolff-Parkinson-White syndrome: a challenging case study

Wolff-Parkinson-White (WPW) syndrome involves connections of myocardial fibers between the atrium and ventricle that can carry electrical impulses outside of the normal conduction system. Treatment options include pharmacologic management, surgical interruption, antitachycardia devices, or transvenous catheter ablation. This is a case study of a patient who underwent surgical ablation of an accessory pathway and reoperation because of continued abnormal conduction. She had tachypalpitations after both procedures and later underwent radiofrequency ablation. Nursing care was complicated because she spoke very little English and was extremely anxious about her illness.

Wolff-Parkinson-White syndrome and the use of radiofrequency catheter ablation

OBJECTIVE

To describe Wolff-Parkinson-White (WPW) syndrome and the use of radiofrequency catheter ablation to prevent further recurrence of the tachycardias associated with this syndrome. The pathophysiology, electrocardiographic findings, treatment modalities for both short- and long-term therapy, as well as the treatment with radiofrequency catheter ablation are presented.

PATHOPHYSIOLOGY

WPW is the most common form of the preexcitation syndromes. Ventricular myocardium is preexcited by use of an alternate conduction pathway or accessory pathway. Electrocardiographic characteristics show a short PR interval, presence of a delta wave, widened QRS complex, and ST-T wave changes. Most common tachyarrhythmias associated with this syndrome are orthodromic and antidromic reciprocating tachycardia and atrial fibrillation.

OUTCOME

There is significant morbidity and mortality associated with WPW. Although rare, some patients' initial presentation may be ventricular fibrillation or sudden cardiac death.

INTERVENTIONS

Short-term therapy will include vagal maneuvers, atrioventricular nodal blocking agents, or direct current cardioversion. Long-term therapy includes antiarrhythmic therapy, and surgical or catheter ablation. NURSING CONSIDERATIONS: Critical Care nurses play an important role in the diagnosis and treatment of the patient with WPW. Recognizing the characteristic signs on the 12-lead electrocardiogram, understanding the proper therapy for arrhythmias, and possessing knowledge of the syndrome to educate the patient are vital pieces of information necessary to care for the patient with WPW.

Wolff-Parkinson-White syndrome

Wolff-Parkinson-White (WPW) syndrome is a cardiac conduction disorder that presents with potentially life-threatening consequences. Wolff-Parkinson-White syndrome-induced dysrhythmias account for 20% of all supraventricular tachycardias that occur in the general population. Clinical presentations range from no symptoms to a sudden cardiac arrest. The risk of sudden death is always present with WPW syndrome, and it is the motivating force in the evaluation and treatment of this syndrome. Current diagnostic modalities are accurate in identifying patients with WPW syndrome, but lack the sensitivity to predict sudden cardiac death. This article reviews the history of WPW syndrome, as well as its general characteristics, diagnostic criteria, treatment modalities, and nursing implications.

Wolff-Parkinson-White syndrome: discharge planning

Some patients with Wolff-Parkinson-White (WPW) syndrome have potentially life-threatening arrhythmias. Symptomatic WPW is associated with tachycardias that are supraventricular in origin. Discharge teaching after surgical correction of WPW is critical to restoring the patient's previous life-style.