WPW syndrome is a pathology in the nerve fibers of the heart muscle that causes tachycardia attacks and is caused by the passage of an exciting nerve impulse along additional shortened paths that are absent in a healthy heart.
First mention
In 1930, medical scientists Wolf, Parkinson and White were the first to describe the signs and mechanism of the syndrome, which was later given the name of the syndrome of ERW (WPW). There is also such a thing as a WPW phenomenon. We will also consider it in this article.
Normally, the fibers in the heart that conduct the nerve stimulating impulse form a specific route that ensures uniform and gradual propagation of the impulse. Signal generation begins in the sinus node in the right atrium, reaches the AV node (atrioventricular node) in the atrioventricular zone, then through the legs of the His bundle through Purkinje fibers, the excitation is transmitted to all muscle fibers of the ventricles of the heart, and such a long path provides coordinated and synchronous contractions whole heart muscle.
Causes and symptoms
In WPW syndrome, the excitation of a nerve impulse from the atrium to the ventricles passes along a short path to the so-called Kent bundle, bypassing the atrioventricular (AV) node. That is, the excitation wave passes much faster than with the normal rhythm of the heartbeat, which is why discoordinations in the contraction of the heart muscle and various types of arrhythmias occur.
That is, the pathways of the heart pulse are disrupted.
Such abnormalities in the structure of the heart are exclusively congenital and form hereditarily due to 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 20-22th week of development, become thinner and completely disappear. If such fibers persist, anatomical prerequisites for WPW syndrome appear. The hereditary form of WPW syndrome is characterized by the presence of a large number of AV compounds, defects and abnormalities in the structure of the heart. However, despite congenital anatomical abnormalities, the first symptoms of WPW syndrome can occur only in adulthood. Of all cases of the presence of this syndrome, 70% is detected in men.
Signs of pathology
The most common signs of a possible WPW syndrome are:
- Feeling of a strong and frequent heartbeat, which children may call "jumping out or pounding heart."
- Sudden dizziness.
- Unreasonable fainting, mostly in childhood and adolescence.
- Pressing pains in the heart, tingling and cutting pains when inhaling.
- A feeling of lack of air, severe shortness of breath at a young age.
- Newborns may refuse to feed, heavy sweating, constant weakness is possible, the heart rate periodically increases to 200-300 beats per minute.
How to identify the disease?
In a large number of people with additional abnormal fibers in the heart muscle, WPW syndrome is diagnosed only when cardiac echocardiography is performed. Decryption will surely produce a result.
Such carriers of the syndrome do not suffer from attacks of tachycardia or arrhythmia and may not even suspect the presence of pathologies in the heart.
Such an asymptomatic course is observed in 35-40% of all identified carriers of the syndrome. A mild course of WPW syndrome is characterized by periodic short-term tachycardia or arrhythmia, which quickly passes without assistance. To eliminate seizures in the case of moderate severity of WPW syndrome, antiarrhythmic drugs or certain types of cardiac excitation blockers are required.
In the case of prolonged attacks, which are practically not removed with medication and are complicated by irregular 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 by the frequency and features of the appearance of various clinical signs and is divided into the following types:
- Manifesting, when a delta wave is constantly present on the electrocardiogram, and AVR tachycardia and sinus rhythm appear sporadically.
- Transient - characterized by transient ventricular pre-excitation.
- Hidden - is described by episodic AVR-tachycardia, but is not diagnosed at rest.
How else can you diagnose the syndrome?
Without an electrocardiogram, you can diagnose a possible WPW syndrome by listening to heart sounds, which will have a frequent pronounced non-rhythmic nature, as well as by irregular heartbeat.
In addition to the ECG, the diagnosis of WPW syndrome is carried out by monitoring using a special portable device with electrodes, ultrasound and echocardiography, the introduction of a stimulating electrode into the esophagus, followed by decoding of the results of electrical pulses, as well as a comprehensive electrophysiological examination, which gives the most accurate model of Kent's bundles in the heart muscle and allows you to recommend conservative or surgical treatment.
WPW phenomenon
In tests for the presence of WPW syndrome, more than 30% of identified carriers of the syndrome have never had any complaints about heart health. Due to the large number of such asymptomatic occurrences, in 1980, WHO published recommendations that separated the WPW syndrome, which has a definite clinical picture, and the WPW phenomenon.
A conclusion is made about such a phenomenon when the sinus rhythm on the electrocardiogram of the heart has 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 geographic 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 deaths; in the examined children, clinical deaths were observed in 2% of cases.
Statistics of the phenomenon of WPW in children
WPW syndrome takes a leading place among the factors causing tachycardia and arrhythmia in children. It is an obvious basis for further cardiac arrhythmias, and even the absence of complaints does not reduce the risk of such pathologies. Any increased physical activity, intense sports, psychological factors can provoke a disruption of the imaginary safe heart activity and even lead to death from a heart attack.
Long-term observations for almost 20 years of a large group of children who have been diagnosed with WPW heart syndrome, from the age of newborns to 18 years, showed the following results:
- 8% of children experienced sudden attacks of ABP-tachycardia;
- 8.2% of the subjects had a transition of the phenomenon into transient WPW syndrome;
- 8.5% experienced short-term loss of consciousness;
- 2% of children had already suffered clinical deaths at the time of the first examination;
- 1.2% - only boys - suddenly died during the examinations;
- only 9% of children with the WPW phenomenon reported the disappearance of these signs.
What is the danger of the WPW phenomenon?
The figures show how unsafe even the presence of the WPW phenomenon is. Such a high percentage of the occurrence of adverse symptoms and pathologies already in childhood gives reason to assume that without sparing physical and emotional stress, without systematic monitoring and therapeutic measures, this percentage and life threat will only increase with age.
Children with the WPW phenomenon should not engage in professional sports and be subjected to constant stress. Caution should be taken when abrupt climatic changes or events cause strong emotional outbursts. All of these factors are very likely to lead to serious illness or death. Persons with a WPW syndrome or phenomenon are not called up for military service.
Treatment and relief of the syndrome
Symptoms and treatment methods are often interrelated. There are many drugs that relieve heart attacks caused by WPW syndrome and significantly reduce the symptoms.
A group of blocking drugs 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 stably stop attacks of ABP tachycardia, normalize the heart rate in 80% of patients, but they also have a number of contraindications in case of hypotension, heart attack, other heart pathologies, childhood and adolescence. Some calcium blockers are categorically contraindicated in WPW syndrome, since against the background of an improvement in the picture of nerve impulse transmission, they malfunction the atria, which has serious irreversible consequences.
Also, in some cases of the use of ATP group drugs, a negative effect on atrial contractions is observed. There are also non-drug methods for stopping the syndrome.
In muscle tissue, nerve impulses pass through the sympathetic and parasympathetic fibers. The first type of fiber activates the work of the heart, the second type slows down heart contractions, being a type of the vagus nerve nervus vagus, and is also called the vagal reflex. That is, the activation of this particular 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 touch on the eyeballs and often helps stop tachycardia.
Also, the vagus nerve is well activated by holding your breath and straining your abdominal muscles, so it’s good to do yoga and breathing exercises with the WPW syndrome or phenomenon.
The method of triggering an inhibitory signal through an electrode inserted into the esophagus very effectively stops severe prolonged tachycardia, but sometimes leads to fibrillation of the heart, therefore it is done in special rooms equipped with a defibrillator.
Defibrillation is carried out only in very severe cases, with a pronounced threat to life, but it often helps to eliminate dangerous foci of extraneous impulses in the heart tissue and normalize the rhythm of the heart.
Surgical treatments for WPW syndrome and their need
If the WPW phenomenon on the ECG is detected, the operational method of elimination is used only in especially difficult cases, with frequent and prolonged tachycardia, which cannot be removed medically, as well as in cases of sudden cardiac death of the patient’s relatives or according to professional indications.
Surgical treatment is recommended only on the basis of a 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 with the WPW phenomenon.
The operation is performed using a special electrode, which is inserted through the femoral artery into the heart muscle through x-ray observation and in certain areas produces radio-cauterization, or ablation, of nerve tissue fibers.
Cryo-destruction of pathological nerve fibers can also be carried out. And in fact, and in another case, the efficiency of the operation reaches 95%. Relapses occur due to incomplete destruction of eliminated foci, as well as in the presence of other undetected formations of nerve tissue. The operation itself can be carried out under local anesthesia, it is practically bloodless, does not cause complications, has a very short recovery period and therefore can be performed at any age.
Cardiology centers in Moscow
Institute of Surgery A.V. Vishnevsky is the pride of Russian medicine, has modern means of treatment and diagnosis, conducts scientific research, diverse high-tech diagnostics and unique cardiological operations. FSBI “NNP Center for Cardiovascular Surgery named after A. N. 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 CardioDom center, you can undergo a complete cardiological examination, receive high-quality therapeutic treatment on an outpatient basis. Cardiology centers in Moscow have proven themselves well, so if you need surgery, you can go there without hesitation.