|Classification according to ICD-10|
|I45||Other cardiac conduction disorders|
|ICD-10 online (WHO version 2019)|
The Wolff-Parkinson-White syndrome (WPW) is a heart rhythm disorder , triggered by an electrically circulating excitation ( circus movement ) between atria and ventricles . This circling takes place via an accessory (= additional ) pathway that is not present in a healthy heart. It was first described in 1930 by the three eponymous cardiologists, the American Louis Wolff , the English John Parkinson and the American Paul Dudley White .
In a healthy heart, there is only one way for electrical excitation to propagate from the atria to the ventricles: the atrioventricular node . In WPW syndrome, there is also a second, rarely several, electrically conductive path between atria and ventricles. In this way, the electrical excitation can be conducted from the ventricle back into the atrium and thus trigger renewed excitation of the ventricles via the AV node after a short time. Since this is clearly premature and then itself in turn triggers the next premature excitation, tachycardia occurs . The tachycardias triggered by WPW syndrome occur in attacks.
In the surface ECG , even at rest, as a sign of the accessory trajectory, there is often an elevation shortly before the R wave, which is superimposed on the Q wave , the so-called delta wave . Paths which only backwards, i.e. H. retrograde, from the ventricle to the atrium, show no delta wave. Such WPW syndromes are also known as concealed WPW syndrome. There are congenital heart defects that are more often associated with WPW syndrome. One example is the rare Ebstein anomaly .
Wolff-Parkinson-White syndrome ( androtropy ) is more common in men than women, and older people are less affected than young people. In principle, however, the disease can appear for the first time at any age. From a statistical point of view, first illnesses occur most frequently in 20 to 30-year-olds, even though the conduction pathway is inherent in principle. According to studies, between 0.1 and 0.3 percent of humanity are affected.
In the WPW syndrome, palpitations (paroxysmal tachycardia ) can occur clinically : Extra beats from the atrium or the ventricle can lead to circus movement tachycardia (CMT), which is either orthodromic (i.e. forward or antegrade over the AV node and backwards or retrograde via the accessory pathway) or antidrom (i.e. antegrade via the accessory pathway and retrograde via the AV node). A typical occurrence is a very fast pulse that starts suddenly as if switched on (frequencies of 160 to 230 beats per minute are common), which is completely uniform, sometimes short, sometimes lasts for hours and ends just as suddenly.
Many patients can end their tachycardias on their own through so-called vagus maneuvers (e.g. strong pressure , drinking cold water, holding breath, lying on their back and stretching their legs as high as possible, ie "making a candle"). The typical sudden onset and end of the arrhythmia is known as the "on-off" phenomenon. With the additional occurrence of a rapidly transferred atrial (atrial) tachyarrhythmia (atrial fibrillation / flutter), a life-threatening high heart rate can also be reached.
First, a resting ECG is written. If this shows clear anomalies, a long-term ECG is also written.
The so-called delta wave is then often seen in the ECG , an expression for the premature excitation of a part of the ventricle in the area of the insertion of the accessory pathway. This also leads to a shortened PQ interval , a widened QRS complex and a change in the ST segment (polarity of the T wave opposite to the delta wave). The ST segment changes are to be assessed as physiological.
In some cases, the patient can stop the seizures himself. This is done via:
- Vagal maneuvers
- To break the tachycardia with antiarrhythmic drugs : Ajmaline is the drug of choice, according to IB evidence also flecainide . Another option is amiodarone .
If this does not succeed or if there is a shock sign, electrical cardioverting should be carried out with the defibrillator .
The Kent bundle as the cause of the WPW tachycardia can be permanently removed by means of catheter ablation . The success rates of this treatment depend on the location of the bundle and are around 90%.
- Louis Wolff, John Parkinson, Paul D. White: Bundle-branch block with short PR interval in healthy young people prone to paroxysmal tachyardia. In: American Heart Journal . Volume 5 (1930), pp. 685-704.
- Heiner Greten , Franz Rinninger, Tim Greten: Internal medicine. 13th edition. Thieme, Stuttgart 2010, ISBN 978-3-13-552213-5 .
- ↑ L. Wolff, J. Parkinson, PD White: Bundle-branch block with short PR interval in healthy young people prone to paroxysmal tachyardia. In: Am Heart J. 5, 1930, pp. 685-704.
- ↑ Heiner Greten, Franz Rinninger, Tim Greten: Internal medicine. 13th edition. Thieme, Stuttgart 2010.
- ^ Anne Paschen: Heart. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 185–283, here: p. 264.