Wolf - Parkinson - White Syndrome

In the normal heart Atrial impulses can be conducted to the ventricles via the AV node only. Excitation (activation, which is earlier than normal) when there is an impulse from the atria bypasses the normal atrioventricular retention and rapidly cools the chamber. In preekscitacionim syndromes are akscesorni consignment roads connecting atrium and infranodalna fiber conduction system in which no holds pulses as in the AV node or connecting atrium and ventricle. Therefore Atrial conduct impulses much faster akscesornim roads and activation of Commerce begins earlier than the momentum going through the AV node to conduct commerce.

In patients with WPW syndrome are frequent attacks of paroxysmal supraventricular tachycardia (rapid heartbeat), which are mainly caused by rapid circular motion pulse frequency, which can first go through the AV node and then through akscesorni time or vice versa.

The cause of

WPW syndrome is a congenital anomaly. Familial occurrence has been described, but not a rule. Most patients, 80-90%, with WPW ECG image or WPW syndrome have a healthy heart. Once the WPW associated with congenital disorders such as Ebstein anomaly, mitral valve prolapse, or hypertrophic cardiomyopathy.

The clinical picture

Patients in the absence of an attack of paroxysmal tachycardia are asymptomatic. The symptoms of these attacks come from arrhythmia. The attacks are usually short-lived usually stop spontaneously, but can be interrupted and vagal stimulation. Some patients may have frequent and prolonged attacks that limit work capacity and reduced quality of life. A smaller percentage of patients may be rare, but expressed episodes quick re-entry tachycardia or atrial fibrillation leading to syncope (loss of consciousness). Rarely, the first and only event in a previously asymptomatic patients with WPW ECG image may be sudden cardiac death due to an attack of atrial fibrillation, which degenerate into ventricular fibrillation.

Diagnosis

WPW syndrome electrocardiogram (ECG) is characterized by a short PR interval, QRS complex, extending from the presence of delta waves in the ascending part of the R wave. In patients with atrial fibrillation can find rare irregular normal ventricular complexes and more frequent ventricular complexes with delta waves.

Treatment

When the attack of paroxysmal tachycardia should first try to stop the attack to stimulate vagal maneuvers. If the attack does not stop, give it some class IC antiarrhythmic drugs (ajmaline, flecainide or propafenone) or class IA (procainamide, quinidine or disopyramide). If the tachycardia stops elektrokardioverzija the method of choice. In patients with frequent attacks electrophysiological studies are needed that can localize Aberrant pathways and surgically severed.