WPW syndrome (you can meet ERW, which stands for Wolf-Parkinson-White syndrome) is a congenital type of disease that affects the heart. In the presence of such a pathology, an additional and, accordingly, an extra path is formed in the heart, which conducts an impulse to the ventricle from the atrium.
The impulse passes along the additional path several times faster than along the normal path (along the atrioventricular node). Because of this, there is a very frequent contraction of the ventricle, and ahead of schedule. Such changes can be seen on the cardiogram, and they will look like a very specific wave. Therefore, if WPW syndrome is suspected, an ECG is performed without fail. An abnormal path can lead to an impulse even in the opposite direction, which can cause the development of arrhythmia.
This pathology is life threatening and can occur without any signs. Diagnoses, selects treatment and monitors the patient arrhythmologist. The pathology can be completely removed only with the help of minimally invasive surgery. It can be performed by a heart surgeon or an arrhythmologist surgeon.
The causes of the disease
WPW syndrome occurs due to abnormalities in the development of the heart of the embryo. Normal is the disappearance of additional pathways after about 20 weeks of gestation. Sometimes the preservation of such pathways is caused by a genetic predisposition or by some factors that adversely affected the course of a woman's pregnancy.
What are the types of disease?
Depending on where exactly the extra path has been preserved, there are two types of WPW syndrome:
- Type A. Kent's bundle is located between the left ventricle and the left atrium. When the impulse passes along an additional path, one of the parts of the left ventricle contracts a little earlier than the other, to which the impulse enters through the atrioventricular node.
- Type B. Kent's bundle is located between the right ventricle and the right atrium. In this situation, one of the parts of the right ventricle will contract ahead of time.
Also, sometimes you can meet the third type AB. In this case, both additional paths conducting pulses are stored. Due to the presence of these pathways, the patient often suffers from arrhythmia attacks.
Separately, it is worth mentioning the phenomenon of ERW. It is interesting in that the abnormal paths will be displayed exclusively on the cardiogram, but there are no arrhythmia attacks. This condition of a person needs constant monitoring, but without treatment.
Symptoms of the syndrome
The main symptom of WPW-heart syndrome are regular attacks of tachycardia. They arise, as a rule, in the case when an abnormal conductive path conducts a pulse in the opposite direction. Because of this, an intensive circulation of the impulse in a circle begins. The atrioventricular node will conduct an impulse from the atrium to the ventricle, and the abnormal path will return from the ventricle back to the atrium. This leads to a strong acceleration of the heart rate, which reaches 140 beats per minute. These are signs of WPW syndrome.
The patient may experience an arrhythmia attack in the form of discomfort or even pain in the heart region, increased heart rate, and a feeling of interruption in the work of the heart muscle may appear. There is also weakness, dizziness begins, sometimes a person may faint. In very rare cases, each attack of arrhythmia is accompanied by a panic reaction in the patient.
It is worth noting that during an attack of arrhythmia (paroxysm), a significant decrease in blood pressure occurs. Most often, such attacks occur as a result of a stressful situation, strong physical exertion, an excess of alcohol in the blood. Less commonly, for no apparent reason.
WPW-heart syndrome is considered very dangerous if a person is prone to atrial flutter or fibrillation. If this happens together with an attack of arrhythmia, then flutter, ventricular fibrillation can begin , which very often causes a fatal outcome.
If signs of WPW syndrome were noticed on the ECG, but there were no attacks of arrhythmia or tachycardia, then this is called the phenomenon of ERW. After some time, in case of attacks, the diagnosis can be changed from a phenomenon to a syndrome.
The first cases of paroxysm often begin to appear at about 10-20 years old. If up to twenty years a person has not had a single episode of paroxysm, the risk of developing ERW syndrome will be very small. Most likely, the phenomenon will not go into a more dangerous form.
How is the disease diagnosed?
With full confidence, the diagnosis of WPW syndrome can be made after performing the following procedures:
- ECG.
- Holter monitoring.
- EFI.
- Ultrasound of the heart muscle.
First of all, the patient is given a cardiogram. If all the signs that are characteristic of the disease are present on it - a delta wave, an expanded QRS complex, a shortened PQ interval, but the patient has absolutely no complaints, then Holter monitoring is additionally prescribed. This procedure will allow you to determine as accurately as possible whether a person suffers from the ERW phenomenon or the syndrome.
"Halter" will determine the presence of even the shortest attack of tachycardia, which the patient may not pay attention to. If several extrasystoles go in a row, then this indicates the presence of arrhythmia microarrays.
In the event that extrasystoles running consecutively in a large number of extrasystoles were recorded on Holter, this indicates that once a patient may develop a real, life-threatening tachycardia attack. After this result, a diagnosis of "ERW syndrome" will be made. After diagnosis, the patient should be constantly monitored by an arrhythmologist, but treatment will only begin after the manifestation of a real paroxysm.
If the presence of the syndrome has been established, then it is necessary to undergo an ultrasound of the heart muscle. Very often situations arise when this syndrome is combined with some other congenital malformations. In this case, the syndrome of ERW on ultrasound will not occur.
It is necessary to undergo such a procedure as an electrophysiological study - EFI. This will allow you to determine as accurately as possible exactly in which place the abnormal path is located. During EFI, an electrode is inserted through the femoral vein into the heart. This procedure can cause various complications, therefore, it is carried out only as a last resort. For example, immediately before surgery.
Therapies
To date, there are several ways to treat WPW syndrome. The choice of therapy will depend on the degree of manifestation of the disease. The presence of other defects and symptoms will also affect.
Arrhythmia attack: its removal
To relieve an attack, it is customary to use medications or vagal tests.
Vagus tests are special techniques with which the vagus nerve is stimulated. These samples include the following:
- carotid sinus massage;
- Mueller's test;
- Valsalva sample;
- You can also wash yourself with cold water while holding your breath.
If vagal tests did not help relieve an arrhythmia attack, then you must immediately take the drug from the list allowed by the doctor. It could be:
- Verapamil.
- Novocainamide.
- "Cordaron."
- "Propafenone."
- "ATF" and so on.
If the case is very difficult, then in order to restore the normal rhythm of the heartbeat, it is necessary to use electric cardioversion or, in extreme cases, transesophageal electrocardiostimulation.
Drug Syndrome Treatment
If a person suffered an attack of arrhythmia, which adversely affected the general blood circulation (she began to feel dizzy, lowered blood pressure, fainting was present), then the doctor should prescribe antiarrhythmic drugs. Such measures are considered prevention of a recurrent attack of arrhythmia.
At the same time, if you constantly take such medications, that is, there is too high a risk of developing a variety of side effects. To date, this method of treating ERW syndrome has become extremely rare. Most often, treatment is carried out using surgical intervention. Medications can be prescribed only if there are certain contraindications or if the operation is impossible due to other reasons.
Surgical treatment
You can completely get rid of ERW syndrome by surgery. A special procedure is carried out - radiofrequency ablation, during which the abnormal path is cauterized, which leads to its complete destruction. As a rule, surgery is prescribed only to those patients in whom tachycardia attacks have an extremely negative effect on blood circulation.
The procedure is one of minimally invasive. A catheter is inserted through the femoral vein directly to the heart, then an additional pathway is cauterized using a radio frequency pulse. The operation is performed only under local anesthesia.
Radiofrequency ablation is considered the most effective treatment for ERW syndrome. A positive result can be achieved in about 95% of all cases. In addition, the risk of complications after surgery is completely low and does not exceed 1%.
What complications can arise after surgery?
The following complications are possible:
- A large hematoma can form at the puncture site.
- Blood clots may form in the heart or deep veins.
- There may be trauma to a vein, an artery through which a catheter was inserted. Situations with trauma to healthy areas of the myocardium, heart valves, coronary arteries are also very rare.
- Coronary artery spasm may occur.
- In isolated cases, atrioventricular block develops.
If you have WPW-heart syndrome, it’s best to trust a doctor with extensive experience to avoid any complications. In order not to cause a hematoma at the puncture site, and in the veins of blood clots, bed rest should be observed during the day before surgery.
When can not ablation?
There are some contraindications to the procedure:
- unstable nature of angina pectoris;
- severe heart failure;
- the body is prone to blood clots;
- the trunk of the left coronary artery is narrowed by more than 75%;
- pronounced stenosis of the aortic valve is observed;
- recent acute myocardial infarction;
- a person suffers from phlebitis or thrombophlebitis of the veins of the lower extremities.
The prognosis in the presence of pathology
Based on many years of medical experience, we can say that the prognosis in the presence of the phenomenon of ERW is quite favorable. If seizures have not begun before the age of 20, then the risk of their development is practically zero. In the case of WPW syndrome, the prognosis can be called conditionally favorable. Approximately 95% of all patients become healthy after radiofrequency ablation of the extra route. This is confirmed by numerous reviews of WPW syndrome.