Wolff–Parkinson–White syndrome

The Wolff- Parkinson -White syndrome ( WPW ) is a heart rhythm disorder, triggered by an electrically circulating excitation ( circus movement) between atria and the ventricles. This is done via an accessory circuits ( = additional) pathway, such as the Kent bundle. In the surface ECG can also be found in peace as a sign of the accessory rail is often a rise just before the R-wave, which is superimposed on the Q wave, the so-called delta wave. Paths which only backwards, that is retrograde, can lead to the atrium from the ventricle, show no delta wave. Such WPW syndrome is also known as concealed WPW. In the healthy heart there is only one way for the electrical excitation propagation from the atria to the ventricles: the AV node. In WPW syndrome, there is usually a second, often multiple, electrically conductive pathways between atria and ventricles. Furthermore, there are congenital heart disease, which often go hand in hand with a Wolff- Parkinson -White syndrome. An example is the rare Ebstein's anomaly.

Epidemiology

More men than women have the Wolff- Parkinson -White syndrome ( Androtropie ) and the elderly are less affected than young people. However, the disease can in principle occur at any age for the first time. First crane depressions occur randomly most commonly seen in 20 - to 30 -year-olds, although the system of the railway line is innate principle. According to studies, between 0.1 and 0.3 percent of humanity are concerned.

Clinic

In WPW syndrome may clinically paroxysmal tachycardia (paroxysmal tachycardia) occur: Through extra beats from the atrium or the ventricle there may be a circus -movement tachycardia (CMT ) may occur, either orthodromically (ie forward or antegrade through the AV node and backwards over the accessory pathway ) or antidromic (ie forward over the accessory pathway and retrograde, ie backwards, is passed over the AV node ). Typical is an occurrence with a suddenly switched on starting very fast pulse (frequencies 160-230 beats per minute are common), which terminates completely uniform partly short, but partly also persists for hours and just as suddenly.

Many patients can make their own by so-called tachycardias Vagusmanöver end (eg, hard pressing, drinking cold water, holding the breath, lie on your back and stretch your legs as high as possible, ie " make a candle "). The typical sudden beginning and ending of the arrhythmia is known as " on-off " phenomenon. With the additional occurrence of rapidly conducted atrial ( atrial ) tachyarrhythmias ( atrial fibrillation / flutter ), however, can also be a life -threatening rapid heart rate can be achieved.

Diagnostics

First, a resting ECG is written, says of this significant anomalies, a long-term ECG is additionally written.

The ECG is often seen then the so-called delta wave, an expression for the premature excitation of a part of the ventricle in the area of ​​insertion of the accessory rail. This leads also to a shortened PQ interval, a widened QRS complex, and a change in the ST segment ( T-wave polarity opposite direction to the delta wave ). The ST-segment changes here are to be regarded as physiological.

Therapy

In some cases, the seizure of the patient may be even stopped. This is done via:

• Vagal maneuvers
• Medical therapy with antiarrhythmic drugs to break the tachycardia: ajmaline is the drug of choice, according to IB evidence also flecainide.

Failure to do so or in case of shock - mark should be electrically cardioverted with the defibrillator.

The Kent bundle as a cause of WPW tachycardia can be eliminated permanently by means of catheter ablation. The success rate of this treatment depends on the location of the bundle and will be around 90%.