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

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.

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.

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

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.