wolf-parkinson-white syndrome

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wolf-parkinson-white syndrome

Wolf-Shrkinson-White Syndrome (WPU)– a syndrome characterized by premature contraction (antesystole) of one of the ventricles (shortening of the PQ interval to 0.1 s or less, widening of the ventricular complex more than 0.11 s, the presence of a D-wave), often with a tendency to develop supraventricular tachycardia, flicker and flutter atrial, due to the conduction of excitation along additional conductive bundles (ACP), connecting the atria directly to the ventricles. WPW syndrome is observed in 25% of cases of paroxysmal atrial tachyarrhythmia. Etiopathogenesis. The WPW phenomenon is a hereditary congenital, traditionally family anomaly (frequency – up to 1-3%). DPP is inherited between the atria and ventricles. The occurrence of supraventricular tachyarrhythmias (in 80% of cases of atrioventricular reciprocal paroxysmal tachycardia) is due to the simultaneous existence of 2 ways of ventricular depolarization, pathological and normal, which causes premature excitation of part or all of the myocardium of the right or left ventricles and normal depolarization of its other departments. Pathomorphology. The presence of DPP between the atria and ventricles – bundles of Kent. DPP – abnormal muscle bundles that cross the atrioventricular sulcus – the remains of embryonic AV connections. Left-sided DPP are located outside the fibrous mitral annulus in the fat layer of the epicardial sulcus,

ECG identification

    • Shortening of the PQ interval less than 0.12 s
    • Deformation of the ascending part of the QRS complex – wave A: notch (step) in the initial third of the ventricular complex
    • Expansion of the QRS complex for more than 0.1 s.

Treatment:

Tactics of conducting

    • Asymptomatic treatment is not required
    • With fainting – electrophysiological study with catheter destruction of the DPP (effective in 95% of patients)
    • With atrioventricular reciprocal and atrial paroxysmal tachycardia – novocainamide, propranolol, adenosine, verapamil, diltiazem
    • With an attack of atrial fibrillation in a patient with WPW syndrome, it is impossible to prescribe cardiac glycosides, verapamil, it is also dangerous to prescribe diltiazem and B-blockers
    • With atrial fibrillation – novocainamide 10 mg / kg IV (at an injection rate of not more than 100 mg / min) or electrical impulse therapy (means of choice). In patients older than 70 years, as well as with severe heart and kidney failure, the dose of novocainamide is reduced by 2 times (see also Atrial fibrillation, Atrial flutter)
    • With the development of ventricular fibrillation – the whole complex of resuscitation measures (see Ventricular fibrillation).

Prevention. To prevent paroxysmal tachyarrhythmias in patients with WPW syndrome, novocainamide, propranolol, amiodarone, quinidine are used. Surgical treatment – elimination of DPP. Complications – atrial fibrillation or flutter, ventricular fibrillation. Since the conductivity of the RAP is higher, ventricular excitation with atrial fibrillation or flutter begins very quickly, which threatens to cause ventricular fibrillation. Forecast. In 60-70% of cases of the WPW phenomenon, patients are completely healthy and able to work. In the absence of rhythm disturbances, the prognosis is quite favorable. The prognosis deteriorates sharply when paroxysms of atrial fibrillation or flutter occur. Synonym. Ventricular Preexcitation Syndrome Abbreviations

    • DPP – additional conductive bundles
    • WPW syndrome – Wolff-Parkinson-White ICD syndrome. 145.6 Preexcitation syndrome Notes
    • The WP phenomenon is an electrocardiographic diagnosis of premature ventricular excitation without its clinical manifestations.
    • WPW syndrome – atrial-ventricular reciprocal or atrial paroxysmal tachyarrhythmias in patients with ECG signs of premature ventricular excitation.