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Wolff-Parkinson-White SyndromeAn Arrhythmia Caused By Extra Electrical ConductionWolff-Parkinson White syndrome is an uncommon heart rhythm abnormality. What makes this condition unique?
Wolff-Parkinson-White (WPW) syndrome is a cardiac condition that occurs in less than 1% of the general population. It is typically congenital and rarely leads to sudden death. However, it can still be distressing to some individuals with the condition. PathophysiologyNormally, the heart contracts in response to electrical conduction. The sinus node in the right atrium of the heart acts as the organ's natural pacemaker, regularly giving off an electrical impulse. This impulse is conducted throughout the atria, causing them to contract, before passing through the atrioventricular (AV) node, bundle of His, and Purkinje fibers to stimulate contraction of the ventricles. WPW syndrome involves the presence of an extra pathway connecting the atria and ventricles. This accessory AV pathway can cause problems because the conduction down the normal electrical pathway through the AV node can go back up the accessory pathway and cycle back through the normal pathway, causing a rapid heart rate (orthodromic tachycardia). Sometimes, the rapid heart rate results from electrical conduction in the other direction, down the accessory pathway and up the normal pathway (antidromic tachycardia). These phenomena generally occur when there is a premature heartbeat or other arrhythmia with a fast heart rate, such as atrial fibrillation. EvaluationWhen the heart beats very quickly, the patient may feel the sensation of rapid heartbeats (palpitations), difficulty with breathing (dyspnea), chest discomfort, and/or fainting. Classic signs on electrocardiography (EKG) include a shortened interval from the P wave to the tip of the QRS complex and a slow uprising of the QRS complex (delta wave). Further evaluation of WPW syndrome can be done with a cardiac electrophysiology (EP) study, performed by cardiologists with expertise in such procedures. During an EP study, the patient has catheters placed into his or her large veins and advanced to the heart chambers. The catheters have electrodes that can trigger and analyze an arrhythmia. In this manner, a cardiologist can find out how the arrhythmia behaves, where the problem lies, and the response to heart rhythm medications. For WPW syndrome, EP studies pinpoint the location of the accessory pathway or pathways. TreatmentMedications to control the heart rate in WPW syndrome include but are not limited to procainamide, flecanide, amiodarone, sotalol, verapimil, and metoprolol. The definitive treatment for WPW syndrome, however, is tissue destruction (ablation) of the accessory pathway. This is done immediately after EP studies using a radiofrequency ablation catheter. The prognosis is often good after such treatment. References
The copyright of the article Wolff-Parkinson-White Syndrome in Heart Disease Diagnosis is owned by Anthony Lee. Permission to republish Wolff-Parkinson-White Syndrome in print or online must be granted by the author in writing.
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