What is the pathophysiology of Wolff-Parkinson-White (WPW) syndrome?

Updated: Jan 08, 2017
  • Author: Christopher R Ellis, MD, FACC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Accessory pathways or connections between the atrium and ventricle are the result of anomalous embryonic development of myocardial tissue bridging the fibrous tissues that separate the two chambers. This allows electrical conduction between the atria and ventricles at sites other than the AV node. Passage through APs circumvents the usual conduction delay between the atria and ventricles, which normally occurs at the AV node, and predisposes the patient to develop tachydysrhythmias.

Although dozens of locations for bypass tracts can exist in preexcitation, including atriofascicular, fasciculoventricular, nodofascicular, or nodoventricular, the most common bypass tract is an accessory AV pathway otherwise known as a Kent bundle. This is the anomaly seen in WPW syndrome. The primary feature that differentiates WPW syndrome from other AP-mediated supraventricular tachycardias (SVTs) is the ability of the AP to conduct in either an antegrade (ie, from atrium to ventricles) or a retrograde manner.

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