WPW Phenomenon: Causes, Symptoms, Diagnosis and Treatment

WPW syndrome is a pathology in the nerve fibers of the heart muscle, which causes attacks of tachycardia and is caused by the passage of an exciting nerve impulse along additional shortened paths absent in a healthy heart.

First mentions

In 1930, medical scientists Wolf, Parkinson and White first described the signs and mechanism of the syndrome, which was later called the WPW syndrome. There is still such a thing as WPW-phenomenon. We will also consider it in this article.

Normally, the fibers in the heart that conduct a nervous excitation pulse form a certain route, which ensures a uniform and gradual spread of the pulse. The signal generation begins at the sinus node in the right atrium, reaches the AV node (atrioventricular node) in the atrioventricular zone, then along the legs of the bundle of His through Purkinje fibers, excitation is transferred to all the muscle fibers of the ventricles of the heart, and such a long path provides coordinated and synchronous contractions Of the whole heart muscle.

Causes and Symptoms

In WPW syndrome, the excitation of the nerve impulse from the atrium to the ventricles passes along a short path to the so-called Kent bundle, bypassing the atrioventricular (AB) node. That is, the excitation wave passes much faster than with the normal rhythm of the heartbeat, which causes discoordination in the contraction of the heart muscle and various types of arrhythmia.

That is, the ways of carrying out the heart pulse are violated.

Similar anomalies in the structure of the heart are exclusively congenital and are formed hereditarily because of the deformed gene or under the influence of other factors adversely affecting the development of the heart of the human embryo.

The fetus always has additional atrioventricular rings and fibers, which by the 22nd-22nd week of development become thinner and completely disappear. If such fibers are preserved, the anatomical prerequisites of WPW syndrome appear. Hereditary form of WPW-syndrome is characterized by the presence of a large number of AB-compounds, defects and anomalies in the structure of the heart. However, despite the congenital anatomical abnormalities, the first symptoms of the WPW syndrome can only appear in adulthood. Of all cases of this syndrome, 70% is detected in men.

Signs of pathology

The most common signs of the possible presence of WPW syndrome are the following:

1. Sensations of strong and frequent heartbeats, which children can call "jumping out or pounding the heart."
2. Sudden dizziness.
3. Unreasonable syncope, mostly in childhood and adolescence.
4. Pressing pains in the heart, tingling and cutting pain when inhaling.
5. Feeling of lack of air, strong shortness of breath already at a young age.
6. Newborns can refuse to feed, sweating is possible, permanent weakness, heart rate increases periodically to 200-300 beats per minute.

How to identify the disease?

In a large number of people who have additional pathological fibers in the heart muscle, WPW syndrome is diagnosed only when cardiac echocardiography is performed. The decryption will necessarily produce the result.

Such carriers of the syndrome do not suffer from tachycardia or arrhythmia and may not even suspect that there are pathologies in the heart.

This asymptomatic course is observed in 35-40% of all identified carriers of the syndrome. The mild degree of WPW syndrome is characterized by intermittent short-term tachycardia or arrhythmia, which passes fairly quickly without outside help. To eliminate seizures in the case of moderate severity of WPW syndrome, antiarrhythmic drugs or certain types of cardiac stimulation blockers are required.

In the case of prolonged seizures that are almost not removed medically and complicated by indiscriminate contractions and fluttering of the heart muscle, a severe degree of the syndrome is diagnosed and surgical treatment is recommended.

Types of Syndrome

WPW heart syndrome is also classified according to the frequency and features of the appearance of various clinical signs and is divided into the following types:

• Manifesting, when the electrocardiogram is constantly present delta wave, and the AVP-tachycardia and sinus rhythm appear sporadically.
• Transient - characterized by transient pre-excitation of the ventricles.
• Hidden - described by episodic AVP-tachycardia, and at rest is not diagnosed.

How else can you diagnose the syndrome?

Without an electrocardiogram, a possible WPW syndrome can be diagnosed by listening to heart sounds, which will have a frequent, non-rhythmic character, and pulse irregularity.

In addition to ECG, the diagnosis of WPW syndrome is monitored using a special portable device with electrodes, the method of ultrasound and echocardiography, the introduction of a stimulating electrode into the esophagus followed by interpretation of the results of electrical impulses, as well as a complex electrophysiological examination that gives the most accurate model of Kent's beams in the heart muscle And allows you to recommend conservative or surgical treatment.

WPW-phenomenon

When testing for the presence of WPW syndrome, more than 30% of the diagnosed carriers of the syndrome have never had any complaints about heart health. In connection with a large number of such asymptomatic leakages, in 1980 WHO published recommendations in which WPW syndrome with a definite clinical picture was divided and WPW-phenomenon.

A conclusion is drawn about this phenomenon when on the cardiac electrocardiogram the sinus rhythm shows signs of premature ventricular excitation, however, no pathological conditions and atrioventricular tachycardia were observed in the subjects.

Despite this, with the WPW phenomenon, the risk of complications is very high, any provoking effect - physical or emotional stress, alcohol, moving to unusual geographical areas - can cause the manifestation of negative symptoms of WPW syndrome. In the adult population, in 0.3% of cases, the WPW phenomenon leads to death, in the examined children clinical deaths were observed in 2% of cases.

Statistics of the WPW phenomenon in children

WPW-syndrome occupies a leading place among the factors that cause tachycardia and arrhythmia in children. It is an obvious base for further cardiac arrhythmia, and even the absence of complaints does not reduce the risk of such pathologies. Any increased physical activity, intense exercise, psychological factors can provoke a breakdown of imaginary healthy heart activity and even lead to death from a heart attack.

Long-term follow-up for almost 20 years for a large group of children who have WPW heart failure, aged between 18 and 18, showed the following results:

• 8% of children experienced sudden attacks of ABP-tachycardia;
• In 8.2% of the subjects there was a transition of the phenomenon to the transient syndrome WPW;
• 8.5% had short-term loss of consciousness;
• 2% of children by the time of the first examination had already suffered clinical deaths;
• 1.2% - only boys - suddenly died during the survey;
• Only 9% of children with the WPW phenomenon registered the disappearance of these characteristics.

What is the danger of the WPW phenomenon?

From these figures it is clear how insecure is even the presence of the WPW phenomenon. Such a high percentage of the emergence of adverse symptoms and pathologies already in childhood gives grounds to assume that, without sparing physical and emotional loads, without systemic supervision and medical treatment with age, this percentage and the threat of life will only increase.

Children with the phenomenon of WPW should not engage in professional sports and be subjected to constant stresses. With caution should be treated to sudden climate changes or activities that cause strong emotional outbursts. All these factors can with high probability lead to serious illnesses or death. Persons who have the presence of a syndrome or the phenomenon of WPW are not recruited for military service.

Treatment and management of the syndrome

Symptoms and methods of treatment are often interrelated. There are many drugs that relieve heart attacks caused by WPW syndrome, and significantly reduce the manifestation of its symptoms.

A group of drugs-blockers normalizes the frequency of contractions of the heart muscle. However, the effectiveness of such drugs is manifested only at the level of 50-60%, and they can not be used with constant hypotension and asthma.

Antiarrhythmic drugs quite steadily stop attacks of ABP-tachycardia, normalize the heart rate in 80% of patients, but also have a number of contraindications in the case of hypotension, heart attack, other heart pathologies, childhood and adolescence. Some calcium blockers are categorically contraindicated in WPW syndrome, as against the background of an improvement in the pattern of nerve impulse transmission, they cause a malfunction in the atria, which has serious irreversible consequences.

Also in a number of cases, the use of ATP group drugs has a negative effect on atrial contractions. There are also non-drug treatment methods for the syndrome.

In the muscle tissue, nerve impulses pass through sympathetic and parasympathetic fibers. The first kind of fibers activates the work of the heart, the second kind slows the heart contractions, being a kind of vagus nerve nervus vagus, and is also called the vagal reflex. That is, activation of this type of reflexes will give the effect of stabilizing the work of the heart. The simplest way to activate vagal impulses is the so-called Ashner reflex, which is provoked by a 20-30-second light depression on the eyeballs and often helps stop the tachycardia.

Also, the vagus nerve is well activated by the delay in breathing and the tension of the abdominal muscles, so that with syndrome or the phenomenon of WPW it is useful to practice yoga and respiratory gymnastics.

The method of triggering a suppressive signal through an electrode inserted into the esophagus very effectively stops a severe prolonged tachycardia, but sometimes leads to fibrillation of the heart, so it is done in special cabinets equipped with a defibrillator.

Defibrillation is performed only in very severe cases, with a pronounced threat of life, but it often helps to eliminate dangerous foci of extraneous impulses in the cardiac tissue and normalize the rhythm of the heart.

Operational methods of treatment of WPW syndrome and their necessity

If the phenomenon of WPW on the ECG is identified, the operative method of elimination is used only in particularly difficult cases, with frequent and prolonged tachycardia that is not withdrawn medically, as well as in cases of sudden cardiac death of relatives of the patient or for professional indications.

Operative treatment is recommended only on the basis of comprehensive and complete examination, which gives the most accurate picture of the structure of pathological tissues in the heart. Therefore, it is worth considering whether to do the operation under the phenomenon of WPW.

The operation is performed using a special electrode, which is introduced through the femoral artery into the cardiac muscle through X-ray observation and in certain areas produces radio-ignition, or ablation, fibers of the nervous tissue.

Cryodestruction of pathological nerve fibers can also be performed. In both cases, the efficiency of the operation reaches 95%. Relapses occur due to incomplete destruction of the removed foci, as well as in the presence of other undiagnosed formations of nerve tissues. The operation itself can be carried out under local anesthesia, practically bloodless, does not cause complications, has a very short recovery period and therefore can be performed at any age.

Cardiological centers in Moscow

Institute of Surgery. AVVishnevsky - pride of domestic medicine, has modern means of treatment and diagnostics, conducts scientific research, diversified high-tech diagnostics and unique cardiological operations. FGBU "NNP Center for Cardiovascular Surgery. AN Bakuleva "carries out medical, scientific and educational activities under the program" Cardiovascular Surgery ".

The Russian Cardiology Research and Production Complex conducts examinations and treatment of heart diseases at a high-tech world level. In the center "CardioDom" it is possible to undergo a complete cardiological examination, to receive quality therapeutic treatment in outpatient settings. Cardiac centers in Moscow have proven themselves well, therefore, when there is a need for surgical intervention, you can go there without thinking.