Wolff-Parkinson-White syndrome differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(49 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Wolff-Parkinson-White syndrome}}
{{Wolff-Parkinson-White syndrome}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{HK}} {{CZ}}
== Differential Diagnosis ==
==Overview==
Diagnosis of Hypertrophy, Bundle Branch Block and MI in the Presence of WPW are all obscured.
 
# Type A WPW
== Differentiating Tachycardia Associated Wolf-Parkinson-White syndrome from other Diseases ==
#* RBBB
<span style="font-size:85%">'''Abbreviations:'''
#* RVH
'''VT:''' [[Ventricular tachycardia]];
#* True posterior MI
'''VF:''' [[Ventricular fibrillation]];
#* IMI
'''AF:''' [[Atrial fibrillation]] ;
# Type B WPW
'''AVNRT:''' [[Atrionodal reentrant tachycardia]];
#* LBBB
'''AV node:''' [[Atrioventricular node]];
#* Anterior MI
'''AVRT:''' [[Atrioventricular reentrant tachycardia]];
#* IMI
'''AT:''' [[Arial tachycardia]];
# WPW and atrial flutter
'''PJRT:''' [[Permanent junctional reciprocating tachycardi]];
#* paroxysmal VT or flutter
'''SNRT:''' [[ Sinus nodal reentrant tachycardia]].
</span><br><ref name="ZazaSuwalski2020">{{cite journal|last1=Zaza|first1=Antonio|last2=Suwalski|first2=Piotr|last3=Sarquella-Brugada|first3=Georgia|last4=Sacher|first4=Frederic|last5=Lambiase|first5=Pier David|last6=Kuck|first6=Karl-Heinz|last7=Kaski|first7=Juan-Carlos|last8=Ho|first8=Siew Yen|last9=Grace|first9=Andrew|last10=Gorenek|first10=Bulent|last11=Gomez-Doblas|first11=Juan J|last12=Diller|first12=Gerhard-Paul|last13=Deftereos|first13=Spyridon G|last14=Corrado|first14=Domenico|last15=Calkins|first15=Hugh|last16=Blomström-Lundqvist|first16=Carina|last17=Bax|first17=Jeroen J|last18=Arribas|first18=Fernando|last19=Arbelo|first19=Elena|last20=Katritsis|first20=Demosthenes G|last21=Brugada|first21=Josep|last22=De Potter|first22=Tom|last23=Sticherling|first23=Christian|last24=Aboyans|first24=Victor|last25=Basso|first25=Cristina|last26=Bocchiardo|first26=Mario|last27=Budts|first27=Werner|last28=Delgado|first28=Victoria|last29=Dobrev|first29=Dobromir|last30=Fitzsimons|first30=Donna|last31=Gevaert|first31=Sofie|last32=Heidbuchel|first32=Hein|last33=Hindricks|first33=Gerhard|last34=Hlivak|first34=Peter|last35=Kanagaratnam|first35=Prapa|last36=Katus|first36=Hugo|last37=Kautzner|first37=Josef|last38=Kriebel|first38=Thomas|last39=Lancellotti|first39=Patrizio|last40=Landmesser|first40=Ulf|last41=Leclercq|first41=Christophe|last42=Lewis|first42=Basil|last43=Lopatin|first43=Yury|last44=Merkely|first44=Béla|last45=Paul|first45=Thomas|last46=Pavlović|first46=Nikola|last47=Petersen|first47=Steffen|last48=Petronio|first48=Anna Sonia|last49=Potpara|first49=Tatjana|last50=Roffi|first50=Marco|last51=Scherr|first51=Daniel|last52=Shlyakhto|first52=Evgeny|last53=Simpson|first53=Iain A|last54=Zeppenfeld|first54=Katja|last55=Arbelo|first55=Elena|last56=Arribas|first56=Fernando|last57=Bax|first57=Jeroen J|last58=Blomström-Lundqvist|first58=Carina|last59=Calkins|first59=Hugh|last60=Deftereos|first60=Spyridon G|last61=Diller|first61=Gerhard-Paul|last62=Gomez-Doblas|first62=Juan J|last63=Gorenek|first63=Bulent|last64=Grace|first64=Andrew|last65=Ho|first65=Siew Yen|last66=Kaski|first66=Juan-Carlos|last67=Kuck|first67=Karl-Heinz|last68=Lambiase|first68=Pier David|last69=Sacher|first69=Frederic|last70=Sarquella-Brugada|first70=Georgia|last71=Suwalski|first71=Piotr|last72=Zaza|first72=Antonio|last73=Windecker|first73=Stephan|last74=Aboyans|first74=Victor|last75=Baigent|first75=Colin|last76=Collet|first76=Jean-Philippe|last77=Dean|first77=Veronica|last78=Delgado|first78=Victoria|last79=Fitzsimons|first79=Donna|last80=Gale|first80=Chris P|last81=Grobbee|first81=Diederick|last82=Halvorsen|first82=Sigrun|last83=Hindricks|first83=Gerhard|last84=Iung|first84=Bernard|last85=Jüni|first85=Peter|last86=Katus|first86=Hugo A|last87=Landmesser|first87=Ulf|last88=Leclercq|first88=Christophe|last89=Lettino|first89=Maddalena|last90=Lewis|first90=Basil S|last91=Merkely|first91=Bela|last92=Mueller|first92=Christian|last93=Petersen|first93=Steffen E|last94=Petronio|first94=Anna Sonia|last95=Richter|first95=Dimitrios J|last96=Roffi|first96=Marco|last97=Shlyakhto|first97=Evgeny|last98=Simpson|first98=Iain A|last99=Sousa-Uva|first99=Miguel|last100=Touyz|first100=Rhian M|last101=Amara|first101=Walid|last102=Grigoryan|first102=Svetlana|last103=Podczeck-Schweighofer|first103=Andrea|last104=Chasnoits|first104=Alexandr|last105=Vandekerckhove|first105=Yves|last106=Sokolovich|first106=Sekib|last107=Traykov|first107=Vassil|last108=Skoric|first108=Bosko|last109=Papasavvas|first109=Elias|last110=Kautzner|first110=Josef|last111=Riahi|first111=Sam|last112=Kampus|first112=Priit|last113=Parikka|first113=Hannu|last114=Piot|first114=Olivier|last115=Etsadashvili|first115=Kakhaber|last116=Stellbrink|first116=Christoph|last117=Manolis|first117=Antonis S|last118=Csanádi|first118=Zoltán|last119=Gudmundsson|first119=Kristjan|last120=Erwin|first120=John|last121=Barsheshet|first121=Alon|last122=De Ponti|first122=Roberto|last123=Abdrakhmanov|first123=Ayan|last124=Jashari|first124=Haki|last125=Lunegova|first125=Olga|last126=Jubele|first126=Kristine|last127=Refaat|first127=Marwan M|last128=Puodziukynas|first128=Aras|last129=Groben|first129=Laurent|last130=Grosu|first130=Aurel|last131=Pavlovic|first131=Nikola|last132=Ibtissam|first132=Fellat|last133=Trines|first133=Serge A|last134=Poposka|first134=Lidija|last135=Haugaa|first135=Kristina H|last136=Kowalski|first136=Oskar|last137=Cavaco|first137=Diogo|last138=Dobreanu|first138=Dan|last139=Mikhaylov|first139=Evgeny N|last140=Zavatta|first140=Marco|last141=Nebojša|first141=Mujović|last142=Hlivak|first142=Peter|last143=Ferreira-Gonzalez|first143=Ignacio|last144=Juhlin|first144=Tord|last145=Reichlin|first145=Tobias|last146=Haouala|first146=Habib|last147=Akgun|first147=Taylan|last148=Gupta|first148=Dhiraj|title=2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)|journal=European Heart Journal|volume=41|issue=5|year=2020|pages=655–720|issn=0195-668X|doi=10.1093/eurheartj/ehz467}}</ref>
 
 
{| class="wikitable"
|-
!Regular [[Narrow complex tachycardia]] (QRS≤ 120ms) !! [[Irregular Narrow complex tachycardia]] (QRS≤ 120ms) !! Regular [[wide QRS tachycardia]](QRS>120ms) !! Irregular [[wide QRS tachycardia]] (QRS>120ms)
|-
|  Physiologic [[sinus tachycardia]]|| [[Atrial fibrillation]] ([[AF]]) || [[Ventricular tachycardia]]/[[flutter]] || [[AF]] or [[atrial flutter]] or [[focal atrial tachycardia]] with varying block conducted with abrerration
|-
| Inappropriate [[sinus tachycardia]] || Focal [[atrial tachycardia]] or [[ atrial flutter]] with varying [[ AV block ]]|| Antidromic [[ AV ]]re-entrant tachycardia || [[Antidromic [[AV]] reentrant tachycardia]] due to nodo-ventricular/fascicular [[accessory pathway]] with variable [[VA conduction]]
|-
| [[Sinus nodal re-entrant tachycardia]] || [[Multifocal atrial tachycardia]] || [[Supraventricular tachycardia]] with aberration/[[bunddle branch block]] (preexcisting or rate-dependent tachycardia || pre-excited [[AF]]
|-
| [[Focal atrial tachycardia]] ||  || [[Atrial]] or [[junction tachycardia]] with [[preexcitation]]/bystander [[accessory pathway]] || [[Polymorphic VT]]
|-
| [[AV nodal re-entrant tachycardia ]]||  || [[Supraventricular tachycardia]] with [[QRS]] widening due to [[electrolyte disturbance]] or [[antiarrhythmic]] drug ||[[ Torsade-de pointed]]
|-
| Orthodromic [[AV]] re-entrant [[tachycardia]] ||  || [[Ventricular pace rhythm]] || [[Ventricular fibrillation]]
|-
| [[Junctional ectopic tachycardia]]
|-
| Ideopathic [[VT]] (high septal [[VT]])   
|}
 
 
{| class="wikitable"
|+
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arrhythmia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rhythm
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rate
! align="center" style="background:#4479BA; color: #FFFFFF;" + |P wave
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PR Interval
! align="center" style="background:#4479BA; color: #FFFFFF;" + |QRS Complex
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Response to Maneuvers
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Co-existing Conditions
|-
|'''Atrial Fibrillation (AFib)<ref name="pmid24837984">{{cite journal |vauthors=Lankveld TA, Zeemering S, Crijns HJ, Schotten U |title=The ECG as a tool to determine atrial fibrillation complexity |journal=Heart |volume=100 |issue=14 |pages=1077–84 |date=July 2014 |pmid=24837984 |doi=10.1136/heartjnl-2013-305149 |url=}}</ref><ref name="pmid22518390">{{cite journal |vauthors=Harris K, Edwards D, Mant J |title=How can we best detect atrial fibrillation? |journal=J R Coll Physicians Edinb |volume=42 Suppl 18 |issue= |pages=5–22 |date=2012 |pmid=22518390 |doi=10.4997/JRCPE.2012.S02 |url=}}</ref>'''
|
* Irregularly irregular
|
* On a 10-second 12-lead [[The electrocardiogram|EKG]] strip, multiply number of [[QRS complexes]] by 6
|
* Absent
*Fibrillatory waves
|
* Absent
|
* Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
|
* Does not break with [[adenosine]] or [[vagal maneuvers]]
|
* 2.7–6.1 million people in the United States have AFib
* 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib
|
* Elderly
* Following [[Coronary artery bypass surgery|bypass surgery]]
*[[Mitral valve disease]]
*[[Hyperthyroidism]]
*[[Diabetes mellitus|Diabetes]]
*[[Heart failure]]
*[[Ischemic heart disease]]
*[[Chronic kidney disease]]
* Heavy [[alcohol]] use
* Left chamber enlargement
|-
|'''[[Atrial Flutter]]'''<ref name="pmid28835836">{{cite journal |vauthors=Cosío FG |title=Atrial Flutter, Typical and Atypical: A Review |journal=Arrhythm Electrophysiol Rev |volume=6 |issue=2 |pages=55–62 |date=June 2017 |pmid=28835836 |pmc=5522718 |doi=10.15420/aer.2017.5.2 |url=}}</ref>
|
* Regular or Irregular
|
* 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) beats per minute (bpm), but 150 is more common
|
* Sawtooth pattern of P waves at 250 to 350 bpm
*Biphasic deflection in V1
|
* Varies depending upon the magnitude of the block, but is short
|
* Less than 0.12 seconds, consistent, and normal in morphology
|
* Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm
|
*[[Incidence]]: 88 per 100,000 individuals
|
*[[Elderly]]
*[[Alcohol]]
|-
|'''[[Atrioventricular nodal reentry tachycardia]] ([[AV nodal reentrant tachycardia|AVNRT]])<ref name="pmid27617092">{{cite journal |vauthors=Katritsis DG, Josephson ME |title=Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia |journal=Arrhythm Electrophysiol Rev |volume=5 |issue=2 |pages=130–5 |date=August 2016 |pmid=27617092 |pmc=5013176 |doi=10.15420/AER.2016.18.2 |url=}}</ref><ref name="pmid20458824">{{cite journal |vauthors=Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T |title=Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway |journal=Acta Cardiol |volume=65 |issue=2 |pages=171–6 |date=April 2010 |pmid=20458824 |doi=10.2143/AC.65.2.2047050 |url=}}</ref>'''<ref name="urlAtrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK499936/ |title=Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid25196716">{{cite journal |vauthors=Schernthaner C, Danmayr F, Strohmer B |title=Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias |journal=Med Princ Pract |volume=23 |issue=6 |pages=543–50 |date=2014 |pmid=25196716 |pmc=5586929 |doi=10.1159/000365418 |url=}}</ref>
|
* Regular
|
* 140-280 bpm
|
*Slow-Fast AVNRT:
**Pseudo-S wave in leads II, III, and AVF
**Pseudo-R' in lead V1.
*Fast-Slow AVNRT
**[[P waves]] between the [[QRS complex|QRS]] and [[T waves]] (QRS-P-T complexes)
*Slow-Slow AVNRT
**Late [[P waves]] after a [[QRS complex|QRS]]
**Often appears as [[atrial tachycardia]].
*Inverted, superimposed on or buried within the [[QRS complex]] (pseudo R prime in V1/pseudo S wave in inferior leads)
|
* Absent ([[P wave]] can appear after the QRS complex and before the T wave, and in atypical AVNRT, the [[P wave]] can appear just before the [[QRS complex]])
|
* Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
*[[QRS complex alternans|QRS alternans]] may be present
|
* May break with [[adenosine]] or [[vagal maneuvers]]
|
* 60%-70% of all [[supraventricular tachycardias]]
|
*[[Structural heart disease]]
*[[Atrial tachyarrhythmias]]
|-
|'''[[Multifocal atrial tachycardia|Multifocal Atrial Tachycardia]]<ref name="pmid2570520">{{cite journal |vauthors=Scher DL, Arsura EL |title=Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment |journal=Am. Heart J. |volume=118 |issue=3 |pages=574–80 |date=September 1989 |pmid=2570520 |doi=10.1016/0002-8703(89)90275-5 |url=}}</ref><ref name="pmid11884328">{{cite journal |vauthors=Goodacre S, Irons R |title=ABC of clinical electrocardiography: Atrial arrhythmias |journal=BMJ |volume=324 |issue=7337 |pages=594–7 |date=March 2002 |pmid=11884328 |pmc=1122515 |doi=10.1136/bmj.324.7337.594 |url=}}</ref>'''
|
* Irregular
|
*[[Atrial]] rate is > 100 beats per minute
|
* Varying morphology from at least three different foci
* Absence of one dominant atrial pacemaker, can be mistaken for [[atrial fibrillation]] if the [[P waves]] are of low amplitude
|
* Variable [[PR interval|PR intervals]], RR intervals, and PP intervals
|
* Less than 0.12 seconds, consistent, and normal in morphology
|
* Does not terminate with [[adenosine]] or [[vagal maneuvers]]
|
* 0.05% to 0.32% of [[electrocardiograms]] in general hospital admissions
|
*[[Elderly]]
*[[Chronic obstructive pulmonary disease]] ([[Chronic obstructive pulmonary disease|COPD]])
|-
|'''Paroxysmal Supraventricular Tachycardia'''
|
* Regular
|
* 150 and 240 bpm
|
* Absent
* Hidden in [[QRS complex|QRS]]
|
* Absent
|
* Narrow complexes (< 0.12 s)
|
* Breaks with [[vagal maneuvers]], [[adenosine]], [[diving reflex]], [[oculocardiac reflex]]
|
*[[Prevalence]]: 0.023 per 100,000
|
*[[Alcohol]]
*[[Caffeine]]
*[[Nicotine]]
*[[Psychological stress]]
*[[Wolff-Parkinson-White syndrome]]
|-
|'''[[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White Syndrome]]<ref name="pmid24982705">{{cite journal |vauthors=Rao AL, Salerno JC, Asif IM, Drezner JA |title=Evaluation and management of wolff-Parkinson-white in athletes |journal=Sports Health |volume=6 |issue=4 |pages=326–32 |date=July 2014 |pmid=24982705 |pmc=4065555 |doi=10.1177/1941738113509059 |url=}}</ref><ref name="pmid10597097">{{cite journal |vauthors=Rosner MH, Brady WJ, Kefer MP, Martin ML |title=Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues |journal=Am J Emerg Med |volume=17 |issue=7 |pages=705–14 |date=November 1999 |pmid=10597097 |doi=10.1016/s0735-6757(99)90167-5 |url=}}</ref>'''
|
* Regular
|
* Atrial rate is nearly 300 bpm and ventricular rate is at 150 bpm
|
* With [[orthodromic]] conduction due to a bypass tract, the [[P wave]] generally follows the [[QRS complex]], whereas in [[AVNRT]], the [[P wave]] is generally buried in the [[QRS complex]].
|
* Less than 0.12 seconds
|
* A [[delta wave]] and evidence of [[ventricular]] pre-excitation if there is conduction to the ventricle via ante-grade conduction down an accessory pathway
* A [[delta wave]] and pre-excitation may not be present because bypass tracts do not conduct ante-grade.
|
* May break in response to [[procainamide]], [[adenosine]], [[vagal maneuvers]]
|
* Worldwide [[prevalence]] of [[Wolff-Parkinson-White syndrome|WPW syndrome]] is 100 - 300 per 100,000
|
*[[Ebstein's anomaly]]
*[[Mitral valve prolapse]]: This cardiac disorder, if present, is associated with left-sided accessory pathways.
*[[Hypertrophic cardiomyopathy]]: This disorder is associated with familial/inherited form of [[Wolff-Parkinson-White syndrome|WPW syndrome]].
*[[Hypokalemic periodic paralysis]]
*[[Pompe disease]]
*[[Tuberous sclerosis]]
|-
|'''[[Ventricular fibrillation|Ventricular Fibrillation]]  ([[VF]])'''<ref name="pmid27899944">{{cite journal |vauthors=Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J |title=Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction |journal=J Geriatr Cardiol |volume=13 |issue=9 |pages=789–797 |date=September 2016 |pmid=27899944 |pmc=5122505 |doi=10.11909/j.issn.1671-5411.2016.09.006 |url=}}</ref><ref name="pmid11334828">{{cite journal |vauthors=Samie FH, Jalife J |title=Mechanisms underlying ventricular tachycardia and its transition to ventricular fibrillation in the structurally normal heart |journal=Cardiovasc. Res. |volume=50 |issue=2 |pages=242–50 |date=May 2001 |pmid=11334828 |doi=10.1016/s0008-6363(00)00289-3 |url=}}</ref><ref name="pmid20142817">{{cite journal |vauthors=Adabag AS, Luepker RV, Roger VL, Gersh BJ |title=Sudden cardiac death: epidemiology and risk factors |journal=Nat Rev Cardiol |volume=7 |issue=4 |pages=216–25 |date=April 2010 |pmid=20142817 |pmc=5014372 |doi=10.1038/nrcardio.2010.3 |url=}}</ref>
|
* Irregular
|
* 150 to 500 bpm
|
* Absent
|
* Absent
|
* Absent (R on T phenomenon in the setting of ischemia)
|
* Does not break in response to [[adenosine]], [[vagal maneuvers]]
|
 
* Initial [[rhythm]] in 23% of out of hospital cardiac arrest
|
* [[Myocardial ischemia]] / [[Myocardial infarction|infarction]]
*[[Cardiomyopathy]]
* Long or short [[QT]] syndrome
* Electrolyte abnormalities ([[hypokalemia]]/[[hyperkalemia]], [[hypomagnesemia]])
* [[Aortic stenosis]]
* [[Aortic dissection]]
* [[Myocarditis]]
* Blunt trauma (Commotio Cordis)
* [[Sepsis]]
* [[Hypothermia]]
* [[Pneumothorax]]
|-
|'''[[Ventricular tachycardia|Ventricular Tachycardia]]'''<ref name="pmid19252119">{{cite journal |vauthors=Koplan BA, Stevenson WG |title=Ventricular tachycardia and sudden cardiac death |journal=Mayo Clin. Proc. |volume=84 |issue=3 |pages=289–97 |date=March 2009 |pmid=19252119 |pmc=2664600 |doi=10.1016/S0025-6196(11)61149-X |url=}}</ref><ref name="pmid21505622">{{cite journal |vauthors=Levis JT |title=ECG Diagnosis: Monomorphic Ventricular Tachycardia |journal=Perm J |volume=15 |issue=1 |pages=65 |date=2011 |pmid=21505622 |pmc=3048638 |doi=10.7812/tpp/10-130 |url=}}</ref>
|
* Regular
|
* > 100 bpm (150-200 bpm common)
|
* Absent
|<br />
 
*Absent
*Initial [[R wave]] in V1, initial r > 40 ms in V1/V2, notched S in V1, initial R in aVR, lead II R wave peak time ≥50 ms, no RS in V1-V6, and atrioventricular dissociation
|
* Wide complex, [[QRS complex|QRS]] duration > 120 milliseconds
|
* Does not break in response to [[procainamide]], [[adenosine]], [[vagal maneuvers]]
|
* 5-10% of patients presenting with AMI
|
*[[Coronary artery disease]]
*[[Aortic stenosis]]
*[[Cardiomyopathy]]
*[[Electrolyte imbalance|Electrolyte imbalances]] (e.g., [[hypokalemia]], [[hypomagnesemia]])
* Inherited [[channelopathies]] (e.g., [[long-QT syndrome]])
*[[Catecholaminergic polymorphic ventricular tachycardia]]
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Myocardial infarction]]
*[[Torsades de pointes]] is a form of polymorphic VT that is often associated with a prolonged [[QT interval]]
|}


==References==
==References==
Line 23: Line 261:
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Needs overview]]
{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 19:45, 9 November 2020

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 differential diagnosis 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 differential diagnosis

CDC onWolff-Parkinson-White syndrome differential diagnosis

Wolff-Parkinson-White syndrome differential diagnosis in the news

Blogs on Wolff-Parkinson-White syndrome differential diagnosis

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Wolff-Parkinson-White syndrome differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Syed Hassan A. Kazmi BSc, MD [3] Cafer Zorkun, M.D., Ph.D. [4]

Overview

Differentiating Tachycardia Associated Wolf-Parkinson-White syndrome from other Diseases

Abbreviations: VT: Ventricular tachycardia; VF: Ventricular fibrillation; AF: Atrial fibrillation ; AVNRT: Atrionodal reentrant tachycardia; AV node: Atrioventricular node; AVRT: Atrioventricular reentrant tachycardia; AT: Arial tachycardia; PJRT: Permanent junctional reciprocating tachycardi; SNRT: Sinus nodal reentrant tachycardia.
[1]


Regular Narrow complex tachycardia (QRS≤ 120ms) Irregular Narrow complex tachycardia (QRS≤ 120ms) Regular wide QRS tachycardia(QRS>120ms) Irregular wide QRS tachycardia (QRS>120ms)
Physiologic sinus tachycardia Atrial fibrillation (AF) Ventricular tachycardia/flutter AF or atrial flutter or focal atrial tachycardia with varying block conducted with abrerration
Inappropriate sinus tachycardia Focal atrial tachycardia or atrial flutter with varying AV block Antidromic AV re-entrant tachycardia [[Antidromic AV reentrant tachycardia]] due to nodo-ventricular/fascicular accessory pathway with variable VA conduction
Sinus nodal re-entrant tachycardia Multifocal atrial tachycardia Supraventricular tachycardia with aberration/bunddle branch block (preexcisting or rate-dependent tachycardia pre-excited AF
Focal atrial tachycardia Atrial or junction tachycardia with preexcitation/bystander accessory pathway Polymorphic VT
AV nodal re-entrant tachycardia Supraventricular tachycardia with QRS widening due to electrolyte disturbance or antiarrhythmic drug Torsade-de pointed
Orthodromic AV re-entrant tachycardia Ventricular pace rhythm Ventricular fibrillation
Junctional ectopic tachycardia
Ideopathic VT (high septal VT)


Arrhythmia Rhythm Rate P wave PR Interval QRS Complex Response to Maneuvers Epidemiology Co-existing Conditions
Atrial Fibrillation (AFib)[2][3]
  • Irregularly irregular
  • Absent
  • Fibrillatory waves
  • Absent
  • Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
  • 2.7–6.1 million people in the United States have AFib
  • 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib
Atrial Flutter[4]
  • Regular or Irregular
  • 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) beats per minute (bpm), but 150 is more common
  • Sawtooth pattern of P waves at 250 to 350 bpm
  • Biphasic deflection in V1
  • Varies depending upon the magnitude of the block, but is short
  • Less than 0.12 seconds, consistent, and normal in morphology
  • Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm
Atrioventricular nodal reentry tachycardia (AVNRT)[5][6][7][8]
  • Regular
  • 140-280 bpm
  • Slow-Fast AVNRT:
    • Pseudo-S wave in leads II, III, and AVF
    • Pseudo-R' in lead V1.
  • Fast-Slow AVNRT
  • Slow-Slow AVNRT
  • Inverted, superimposed on or buried within the QRS complex (pseudo R prime in V1/pseudo S wave in inferior leads)
  • Absent (P wave can appear after the QRS complex and before the T wave, and in atypical AVNRT, the P wave can appear just before the QRS complex)
  • Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
  • QRS alternans may be present
Multifocal Atrial Tachycardia[9][10]
  • Irregular
  • Atrial rate is > 100 beats per minute
  • Varying morphology from at least three different foci
  • Absence of one dominant atrial pacemaker, can be mistaken for atrial fibrillation if the P waves are of low amplitude
  • Less than 0.12 seconds, consistent, and normal in morphology
Paroxysmal Supraventricular Tachycardia
  • Regular
  • 150 and 240 bpm
  • Absent
  • Hidden in QRS
  • Absent
  • Narrow complexes (< 0.12 s)
Wolff-Parkinson-White Syndrome[11][12]
  • Regular
  • Atrial rate is nearly 300 bpm and ventricular rate is at 150 bpm
  • Less than 0.12 seconds
  • A delta wave and evidence of ventricular pre-excitation if there is conduction to the ventricle via ante-grade conduction down an accessory pathway
  • A delta wave and pre-excitation may not be present because bypass tracts do not conduct ante-grade.
Ventricular Fibrillation (VF)[13][14][15]
  • Irregular
  • 150 to 500 bpm
  • Absent
  • Absent
  • Absent (R on T phenomenon in the setting of ischemia)
  • Initial rhythm in 23% of out of hospital cardiac arrest
Ventricular Tachycardia[16][17]
  • Regular
  • > 100 bpm (150-200 bpm common)
  • Absent
  • Absent
  • Initial R wave in V1, initial r > 40 ms in V1/V2, notched S in V1, initial R in aVR, lead II R wave peak time ≥50 ms, no RS in V1-V6, and atrioventricular dissociation
  • Wide complex, QRS duration > 120 milliseconds
  • 5-10% of patients presenting with AMI

References

  1. ↑ Zaza, Antonio; Suwalski, Piotr; Sarquella-Brugada, Georgia; Sacher, Frederic; Lambiase, Pier David; Kuck, Karl-Heinz; Kaski, Juan-Carlos; Ho, Siew Yen; Grace, Andrew; Gorenek, Bulent; Gomez-Doblas, Juan J; Diller, Gerhard-Paul; Deftereos, Spyridon G; Corrado, Domenico; Calkins, Hugh; Blomström-Lundqvist, Carina; Bax, Jeroen J; Arribas, Fernando; Arbelo, Elena; Katritsis, Demosthenes G; Brugada, Josep; De Potter, Tom; Sticherling, Christian; Aboyans, Victor; Basso, Cristina; Bocchiardo, Mario; Budts, Werner; Delgado, Victoria; Dobrev, Dobromir; Fitzsimons, Donna; Gevaert, Sofie; Heidbuchel, Hein; Hindricks, Gerhard; Hlivak, Peter; Kanagaratnam, Prapa; Katus, Hugo; Kautzner, Josef; Kriebel, Thomas; Lancellotti, Patrizio; Landmesser, Ulf; Leclercq, Christophe; Lewis, Basil; Lopatin, Yury; Merkely, Béla; Paul, Thomas; Pavlović, Nikola; Petersen, Steffen; Petronio, Anna Sonia; Potpara, Tatjana; Roffi, Marco; Scherr, Daniel; Shlyakhto, Evgeny; Simpson, Iain A; Zeppenfeld, Katja; Arbelo, Elena; Arribas, Fernando; Bax, Jeroen J; Blomström-Lundqvist, Carina; Calkins, Hugh; Deftereos, Spyridon G; Diller, Gerhard-Paul; Gomez-Doblas, Juan J; Gorenek, Bulent; Grace, Andrew; Ho, Siew Yen; Kaski, Juan-Carlos; Kuck, Karl-Heinz; Lambiase, Pier David; Sacher, Frederic; Sarquella-Brugada, Georgia; Suwalski, Piotr; Zaza, Antonio; Windecker, Stephan; Aboyans, Victor; Baigent, Colin; Collet, Jean-Philippe; Dean, Veronica; Delgado, Victoria; Fitzsimons, Donna; Gale, Chris P; Grobbee, Diederick; Halvorsen, Sigrun; Hindricks, Gerhard; Iung, Bernard; Jüni, Peter; Katus, Hugo A; Landmesser, Ulf; Leclercq, Christophe; Lettino, Maddalena; Lewis, Basil S; Merkely, Bela; Mueller, Christian; Petersen, Steffen E; Petronio, Anna Sonia; Richter, Dimitrios J; Roffi, Marco; Shlyakhto, Evgeny; Simpson, Iain A; Sousa-Uva, Miguel; Touyz, Rhian M; Amara, Walid; Grigoryan, Svetlana; Podczeck-Schweighofer, Andrea; Chasnoits, Alexandr; Vandekerckhove, Yves; Sokolovich, Sekib; Traykov, Vassil; Skoric, Bosko; Papasavvas, Elias; Kautzner, Josef; Riahi, Sam; Kampus, Priit; Parikka, Hannu; Piot, Olivier; Etsadashvili, Kakhaber; Stellbrink, Christoph; Manolis, Antonis S; Csanádi, Zoltán; Gudmundsson, Kristjan; Erwin, John; Barsheshet, Alon; De Ponti, Roberto; Abdrakhmanov, Ayan; Jashari, Haki; Lunegova, Olga; Jubele, Kristine; Refaat, Marwan M; Puodziukynas, Aras; Groben, Laurent; Grosu, Aurel; Pavlovic, Nikola; Ibtissam, Fellat; Trines, Serge A; Poposka, Lidija; Haugaa, Kristina H; Kowalski, Oskar; Cavaco, Diogo; Dobreanu, Dan; Mikhaylov, Evgeny N; Zavatta, Marco; Nebojša, Mujović; Hlivak, Peter; Ferreira-Gonzalez, Ignacio; Juhlin, Tord; Reichlin, Tobias; Haouala, Habib; Akgun, Taylan; Gupta, Dhiraj (2020). "2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)". European Heart Journal. 41 (5): 655–720. doi:10.1093/eurheartj/ehz467. ISSN 0195-668X.
  2. ↑ Lankveld TA, Zeemering S, Crijns HJ, Schotten U (July 2014). "The ECG as a tool to determine atrial fibrillation complexity". Heart. 100 (14): 1077–84. doi:10.1136/heartjnl-2013-305149. PMID 24837984.
  3. ↑ Harris K, Edwards D, Mant J (2012). "How can we best detect atrial fibrillation?". J R Coll Physicians Edinb. 42 Suppl 18: 5–22. doi:10.4997/JRCPE.2012.S02. PMID 22518390.
  4. ↑ Cosío FG (June 2017). "Atrial Flutter, Typical and Atypical: A Review". Arrhythm Electrophysiol Rev. 6 (2): 55–62. doi:10.15420/aer.2017.5.2. PMC 5522718. PMID 28835836.
  5. ↑ Katritsis DG, Josephson ME (August 2016). "Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia". Arrhythm Electrophysiol Rev. 5 (2): 130–5. doi:10.15420/AER.2016.18.2. PMC 5013176. PMID 27617092.
  6. ↑ Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T (April 2010). "Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway". Acta Cardiol. 65 (2): 171–6. doi:10.2143/AC.65.2.2047050. PMID 20458824.
  7. ↑ "Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf".
  8. ↑ Schernthaner C, Danmayr F, Strohmer B (2014). "Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias". Med Princ Pract. 23 (6): 543–50. doi:10.1159/000365418. PMC 5586929. PMID 25196716.
  9. ↑ Scher DL, Arsura EL (September 1989). "Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment". Am. Heart J. 118 (3): 574–80. doi:10.1016/0002-8703(89)90275-5. PMID 2570520.
  10. ↑ Goodacre S, Irons R (March 2002). "ABC of clinical electrocardiography: Atrial arrhythmias". BMJ. 324 (7337): 594–7. doi:10.1136/bmj.324.7337.594. PMC 1122515. PMID 11884328.
  11. ↑ Rao AL, Salerno JC, Asif IM, Drezner JA (July 2014). "Evaluation and management of wolff-Parkinson-white in athletes". Sports Health. 6 (4): 326–32. doi:10.1177/1941738113509059. PMC 4065555. PMID 24982705.
  12. ↑ Rosner MH, Brady WJ, Kefer MP, Martin ML (November 1999). "Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues". Am J Emerg Med. 17 (7): 705–14. doi:10.1016/s0735-6757(99)90167-5. PMID 10597097.
  13. ↑ Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J (September 2016). "Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction". J Geriatr Cardiol. 13 (9): 789–797. doi:10.11909/j.issn.1671-5411.2016.09.006. PMC 5122505. PMID 27899944.
  14. ↑ Samie FH, Jalife J (May 2001). "Mechanisms underlying ventricular tachycardia and its transition to ventricular fibrillation in the structurally normal heart". Cardiovasc. Res. 50 (2): 242–50. doi:10.1016/s0008-6363(00)00289-3. PMID 11334828.
  15. ↑ Adabag AS, Luepker RV, Roger VL, Gersh BJ (April 2010). "Sudden cardiac death: epidemiology and risk factors". Nat Rev Cardiol. 7 (4): 216–25. doi:10.1038/nrcardio.2010.3. PMC 5014372. PMID 20142817.
  16. ↑ Koplan BA, Stevenson WG (March 2009). "Ventricular tachycardia and sudden cardiac death". Mayo Clin. Proc. 84 (3): 289–97. doi:10.1016/S0025-6196(11)61149-X. PMC 2664600. PMID 19252119.
  17. ↑ Levis JT (2011). "ECG Diagnosis: Monomorphic Ventricular Tachycardia". Perm J. 15 (1): 65. doi:10.7812/tpp/10-130. PMC 3048638. PMID 21505622.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Wolff-Parkinson-White_syndrome_differential_diagnosis&oldid=1674781"