ERW syndrome or Wolf – Parkinson – White disease is a congenital anomaly in the structure of the heart. In the presence of a Kent bundle - an additional direction from the atria to the ventricles, this is the most common syndrome of early ventricular activation. Most people with this disease, which is more often found in men than in women, have no signs of heart disease. The Kent bundle is an abnormal accumulation of myocardial fibers located in the region between one of the ventricles and the left atrium, which is of great importance in the pathogenesis of painful deviation.
In some patients, the syndrome of ERW may not have any clinical manifestations other than arrhythmia. In half of the patients with this anomaly, paroxysmal tachyarrhythmias are revealed: atrial flutter and atrial fibrillation, as well as supraventricular reciprocal arrhythmias. This syndrome often accompanies heart diseases such as mitral valve prolapse, Ebstein's abnormality, and hypertrophic cardiomyopathy.
Since the syndrome of ERW can occur in a latent form, its detection is possible only with electrical stimulation of the ventricles. This is due to the limited capabilities of the conducting paths to transmit pulses in the antegrade direction. On the cardiogram during the sinus rhythm, the manifestations of early ventricular activation will not be reflected. Pronounced ERW disease has the following ECG signs: short interval P - R, P - Q; wave D; expansion of the QRS complex; tachyarrhythmias.
ERW syndrome can be detected at any age, starting with a newborn. Any heart disease that occurs with a distortion of AV conduction can contribute to its manifestation. The constant manifestation of ERW disease accompanied by arrhythmia attacks distorts intracardiac hemodynamics, which inevitably leads to expansion of the heart chambers and a decrease in the ability of the myocardium to contract. Symptoms of the disease largely depend on the duration and frequency of tachyarrhythmias. In 4% of cases with this disease, coronary death occurs, usually due to fatal arrhythmias.
ERW syndrome treat and prevent attacks in various ways: to prevent an attack of tachycardia, antiarrhythmic drugs are used; when supraventricular tachycardia occurs, jet, intravenous administration of adenosine triphosphate is used, which causes short-term cardiac arrest and its further restart; when atrial fibrillation syndrome occurs, urgent electrical defibrillation is performed with further destruction of additional conduction pathways.
Wolff-Parkinson-White syndrome is treated with surgical intervention in the following cases: determination of frequent attacks of atrial fibrillation; the presence of tachyamitria attacks with hemodynamic disorders; the presence of an attack after antiarrhythmic therapy; in cases of contraindications to prolonged drug therapy.
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