What is included in the inpatient evaluation and management 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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Answer

Patients with WPW syndrome who are admitted to the hospital after initiation of medical treatment in the ED may require further evaluation and management as follows:

  • Continuous telemetry monitoring to look for resurgence of tachyarrhythmia and the degree of control of the ventricular rate in those with atrial fibrillation
  • Initiation, dose adjustment, and maintenance of long-term antiarrhythmic drugs for preventing recurrences (However, patients generally undergo RF ablation.)
  • Laboratory evaluation and correction of electrolyte and metabolic abnormalities that may have acted as triggers
  • Carefully monitor for proarrhythmias, especially when quinidine, amiodarone, dofetilide, or sotalol are initiated.

A few days of inpatient telemetry monitoring, including determination of QT interval lengthening on electrocardiographic (ECG) readings, is required for some of these agents. An increase in the QT interval of 25% to longer than 500 ms or 550 ms with a bundle-branch block should be avoided.


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