WPW syndrome

WPW syndrome: description

WPW syndrome is a cardiac arrhythmia. The name goes to the American cardiologist L. Wolff, P.D. White and J. Parkinson back (Wolf-Parkinson-White). In 1930, they described the signs of WPW syndrome in young patients. These include seizures of sudden palpitations (tachycardia) and changes in the so-called electrocardiogram, which records the electrical activity of the heart.

The heartbeat has a clock, the so-called sinus node. He sits in the right atrium of the heart and dictates how fast his heart beats. For this purpose, it sends electrical signals to the so-called atrioventricular node (AV node), which lies between the atria and the heart chambers. At this point, many electrical excitations are filtered. Approximately sixty to eighty excitations reach the AV node every minute. The AV node forwards the excitations via two pathways to the left and right ventricle.

Additional excitation line

In WPW syndrome, sufferers have an additional (accessory) pathway between the atrium and the ventricle. The conduction path can lead from the forecourt into the chamber or vice versa. The excitations from the sinus node, but also excitements from the heart chambers meet this additional pathway. Unlike the AV node, the arousal is not filtered and all electrical signals are routed to the muscle cells of the ventricles.

Since the additional pathway can also lead in the “wrong” direction, the electrical signals of the muscle cells in the heart chambers run back into the atrium. The result is a so-called circular excitement, which makes the heart beat very fast, but in a steady rhythm.

The additional pathway of the WPW syndrome is innate. Mostly, complaints such as palpitations occur in adolescence. The WPW syndrome is more common in men than in women.

WPW syndrome: symptoms

The WPW syndrome does not cause symptoms in all cases. Sometimes the extra pathway is only detected by the changes in the electrocardiogram.

The most common symptoms include a sudden heart rate (tachycardia). The heart beats between 150 and 240 times per minute. Normal are 60 to 80 beats per minute, if you sit quietly. The pulse is very regular in WPW tachycardia.

Some patients experience tachycardia as an increased heart rate. In medicine one speaks then of “Palpitationen”. Other sufferers feel a “heart stumbling”. These sensations usually disappear just as abruptly as they came. In addition, sufferers may experience dizziness, chest pain and shortness of breath. After the tachycardia they are often tired and have a strong urge to urinate.

Fear and powerlessness

The heart rate causes anxiety in many patients. Dizziness and shortness of breath can intensify this feeling. Due to the high heart rate, the heart sometimes can not pump enough blood into the body organs. Some patients therefore lose consciousness.

WPW syndrome in newborns

Very rarely occur in the WPW syndrome in childhood symptoms. The babies are noticeably pale during a tachycardia and breathe very quickly. They may refuse to eat and drink, be easily irritable or cry a lot. In some cases, they get a fever. The WPW syndrome can be more dangerous for children than for adults due to the immature heart structure.

WPW syndrome: causes and risk factors

The cause of the WPW syndrome is unknown. However, it is believed that the extra pathway was created due to a defect in the embryonic development of the heart. Researchers also found that the WPW syndrome is more common with other congenital heart defects. These include defects in the partitions between the right and left side of the heart (ventricular septal defects).

Even with the rare Ebstein anomaly, in which the heart valve between the right atrium and the right ventricle malformed, there is often a WPW syndrome. Since certain gene alterations could be linked to the WPW syndrome, the system is very likely to be inheritable for a WPW syndrome.

WPW syndrome: examinations and diagnosis

When diagnosing the WPW syndrome, the additional pathway must be detected.

First, the doctor will ask some questions about the symptoms:

• Do you have tachycardia that begins suddenly and ends abruptly?
• How often do you have these seizures?
• How long do they last?
• Can you still feel and count your pulse?
• Do you feel like “stumbling” your heart?
• Do you feel dizzy?
• Have you ever lost consciousness?
• Can you stop the attacks by holding your breath, pressing in your stomach or drinking cold water?
• Is a heart defect known to you?
• Has your family already had WPW syndrome?

This is followed by a physical examination. If the patient has palpitations, an electrocardiogram can be written first, so that he can be treated as quickly as possible.

electrocardiogram

An important study for suspected WPW syndrome is the electrocardiogram (ECG). A writer records the electrical activity of the heart. In some cases, the doctor already diagnoses a WPW syndrome. ECG and long-term ECG are only preliminary examinations for the actual electrophysiological examination. Following the ECG, the doctor may administer a medication that stops the tachycardia.

Holter

Sometimes a long-term ECG has to be done. The ECG device is connected to electrodes that are glued to the chest. It records the heartbeat for 24 hours. Sometimes a tachycardia is detected.

If this is not possible, a so-called event recorder can also be used. It is smaller than a long-term ECG device and is worn over a longer period of time. When patients feel tachycardia, they need to press a button on the recorder that records the heart action. There are also recorders (LOOP recorders) that are implanted under the skin in the left breast area. The advantage is that the patient then does not pay attention to his heartbeat and no device has to carry around noticeably.

Exercise ECG

Sometimes a stress ECG is also performed. To do this, the patient must exercise a physical strain on an exercise bike while connected to an ECG recorder. Physical exercise can trigger tachycardia in some cases.

Electrophysiological examination

To safely diagnose the WPW syndrome, a so-called electrophysiological examination (EPU) must be performed. This is a special form of cardiac catheterization. The patient is inserted two thin wires (catheters) via the inguinal veins into the great vena cava and advanced to the heart. There, the catheters measure electrical signals at various points of the heart muscle wall. During the examination, the syndrome can be treated simultaneously.

WPW syndrome: treatment

The only, but very effective, way to cure patients with WPW syndrome is ablation. Medications relieve symptoms only temporarily. In addition, there are certain maneuvers that can slow down the heartbeat in a tachycardia. When the person takes deep breaths, stops the air and presses against the hold of the air, the heart rate often drops. You can also massage the carotid artery, drink ice-cold water or put a bag of ice on your face. Reflectively, the heartbeat is throttled.

EPU and ablation

The greatest value in the treatment of WPW syndrome is the EPU. With the EPU, it is possible to seek out the additional pathway and directly obliterate it (catheter ablation). Thus, the faulty line in the heart is permanently interrupted. The WPW syndrome can be cured by ablation in almost 99 percent of cases. People of certain occupational groups, such as pilots or train drivers with a diagnosed WPW syndrome, may only continue their profession if they have successfully undergone ablation.

drugs

Certain medications can stop the tachycardia in WPW syndrome. They are usually injected via the vein. Examples are adenosine or ajmaline. There are also medications that are taken permanently to prevent the heart racing. An example of this are β-blockers. However, the only treatment that can cure those affected by WPW syndrome is ablation.

electrocardioversion

Sometimes a tachycardia also requires a so-called electrocardioversion. The heart of the patient is stimulated by two electrodes (“paddles”) on the chest as in a resuscitation with electricity. The patient is briefly anesthetized for this purpose. The pulse sometimes causes the heart to fall into its normal rhythm.

WPW syndrome: disease course and prognosis

The WPW syndrome is rarely dangerous. The tachycardia is often very unpleasant. Since it can sometimes last for hours, those affected are exhausted after a tachycardia.

Some people are very susceptible to cardiac arrhythmia because they have a special job, such as competitive sports. However, ablation is a very effective therapy that can cure those affected in most cases.

In people with frequent palpitations, however, there is a risk that a malignant cardiac arrhythmia is triggered. There is a persistent electrical arousal in the atrium, a so-called atrial fibrillation. The additional line passes the pulses unfiltered to the chambers. It can come to ventricular fibrillation. Men between the ages of 30 and 50 are at particular risk of developing such a cardiac arrhythmia.

Affected persons can influence the tachycardia themselves by performing the mentioned maneuvers. Sometimes, influences that often trigger tachycardia should be avoided. These include alcohol or intense sports.

Since the WPW syndrome most likely also has a hereditary component, the family members should also be informed about the disease and, if necessary, examined. Diagnosing that WPW syndrome early, complications can be avoided.