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Wolff-Parkinson-White Syndrome: Review of Literature

Bharthi R*

Department of Pharmacy, Osmania University, Hyderabad, India

*Corresponding Author:
Bharthi R
Department of Pharmacy, Osmania University, Hyderabad, India.
E-mail: bartirudroju@gmail.com

Received date: 23/08/2016 Accepted date: 29/08/2016 Published date: 31/08/2016

Visit for more related articles at Research & Reviews: Journal of Medical and Health Sciences

Abstract

Wolff-Parkinson-White (WPW) disorder is a condition in which there is an additional electrical pathway in the heart. The condition can prompt times of fast heart rate (tachycardia). WPW disorder is a standout amongst the most widely recognized reasons for quick heart rate issues in babies and youngsters. The patient with the Wolff-Parkinson-White (WPW) ECG design has much in the same way as patients with different elements, for example, long-QT disorder and Brugada disorder, which are connected with a recognizing variation from the norm on ECG. All are generally amiable in the lion's share of beset people however in any case convey a danger of unforeseen sudden passing, which asks for some endeavour at danger administration. The WPW pattern differs from the others in that a highly effective curative procedure is available, albeit with some risk, leaving us with a decision to manage expectantly or intervene.

Keywords

Wolff-parkinson-white syndrome; Electrophysiology; Tachyarrhythmia’s; Ablation.

Introduction

Causes

Normally, electrical signs complete a specific pathway the heart. This helps the heart beat frequently. This keeps the heart from having additional thumps or pulsates happening too early.

In individuals with WPW disorder, a portion of the heart's electrical signs go down an additional pathway. This may bring about an extremely fast heart rate called supraventricular tachycardia [1,2].

A great many people with WPW disorder don't have whatever other heart issues. Be that as it may, this condition has been connected with other heart conditions, for example, Ebstein irregularity [3-5]. A type of the condition likewise keeps running in families (Figure 1).

health-sciences-normal-heart

Figure 1: Comparison of normal heart and WPW disordered heart [6].

Symptoms

The clinical manifestations of WPW syndrome reflect the associated tachyarrhythmia episodes—rather than the anomalous ventricular excitation per se. They may have their onset at any time from childhood to middle age and they can vary in severity from mild chest discomfort or palpitations with or without syncope to severe cardiopulmonary compromise and cardiac arrest [7-20]. Thus, presentation varies by patient age.

Infants may present with the following:

 Tachypnea

 Irritability

 Irritability

 Intolerance of feedings

 Evidence of congestive heart failure if the episode has been untreated for several hours

 A history of not behaving as usual for 1-2 days

 An intercurrent febrile illness may be present

 A verbal child with WPW syndrome usually reports the following:

 Chest pain

 Palpitations

 Breathing difficulty

Older patients can usually describe the following:

 Sudden onset of a pounding heartbeat

 Pulse that is regular and “too rapid to count”

 Typically, a concomitant reduction in their tolerance for activity

Physical findings include the following:

 Normal cardiac examination findings in the vast majority of cases

 During tachycardia episodes, the patient may be cool, diaphoretic, and hypotensive

 Crackles in the lungs from pulmonary vascular congestion (during or following an SVT episode)

 Many young patients may present with resting tachycardia on examination, with only minimal symptoms (e.g. palpitations, weakness, mild dizziness) despite exceedingly fast heart rates.

Clinical features of associated cardiac defects may be present, such as the following [21-46]:

 Cardiomyopathy

 Ebstein anomaly

 Hypertrophic cardiomyopathy

Exams and Tests

A physical exam done during a tachycardia scene will demonstrate a heart rate quicker than 100 pulsates every moment. An ordinary heart rate is 60 to 100 pulsate every moment in grown-ups and under 150 beats for each moment in babies, newborn children, and little youngsters. Circulatory strain will be typical or low as a rule [47-60]. On the off chance that the individual is not having tachycardia at the season of the exam, the outcomes might be typical. The condition might be determined to have an ECG or with constant or individual activated walking ECG monitoring, for example, a Holter monitor (Figure 2).

health-sciences-physiologic-study

Figure 2: A test called an electro physiologic study (EPS) is done using catheters that are placed in the heart. This test may help identify the location of the extra electrical pathway.

Diagnosis

WPW is normally analyzed on the premise of the electrocardiogram in an asymptomatic person. For this situation it is showed as a delta wave, which is a slurred upstroke in the QRS complex that is connected with a short PR interim. The short PR interim and slurring of the QRS complex is really the motivation enduring to the ventricles rashly (over the frill pathway) immediately experienced in the AV hub [61-85].

On the off chance that a man with WPW encounters scenes of atrial fibrillation, the ECG demonstrates a fast polymorphic wide-complex tachycardia (without torsade’s de pointes). This blend of atrial fibrillation and WPW is viewed as hazardous, and most antiarrhythmic medications are contraindicated.

At the point when an individual is in typical sinus cadence, the ECG attributes of WPW are a short PR interim (under 120 ms in length), broadened QRS complex (more prominent than 120 ms in term) with slurred upstroke of the QRS complex, and optional repolarization changes (reflected in ST portion T wave changes).

In people with WPW, electrical movement that is started in the SA hub goes through the adornment pathway and through the AV hub to initiate the ventricles by means of both pathways. Since the adornment pathway does not have the motivation moderating properties of the AV hub, the electrical drive first initiates the ventricles through the extra pathway, and instantly a while later by means of the AV hub. This gives the short PR interim and slurred upstroke of the QRS complex known as the delta wave [86-95].

In the event of sort A pre-excitation (left atrioventricular associations), a positive R wave is seen in V1 ("positive delta") on the precordial leads of the electrocardiogram, while in sort B pre-excitation (right atrioventricular associations), a prevalently negative delta wave is found in lead V1 ("negative delta") (Figure 3).

Individuals with WPW may have more than one extra pathway—now and again, upwards of eight irregular pathways have been found. This has been found in people with Ebstein's abnormality.

Wolff–Parkinson–White disorder is once in a while connected with Leber's inherited optic neuropathy (LHON), a type of mitochondrial infection.

health-sciences-demonstrating-characteristic

Figure 3: One beat from a rhythm strip in V2 demonstrating characteristic findings in Wolff–Parkinson–White syndrome. Note the characteristic delta wave (above the blue bar), the short PR interval (red bar) of 80 ms and the long QRS complex (blue bar plus green bar) at 120 ms.

Differential Diagnosis

 Atrial fibrillation.

 Atrial flutter.

 Atrioventricular nodal re-entry tachycardia (AVNRT).

 Sinus node dysfunction.

 Ventricular fibrillation.

 Ventricular tachycardia.

 Ebstein's anomaly.

 Lown-Ganong-Levine syndrome.

 Other causes of syncope.

Treatment

Pharmaceuticals, especially antiarrhythmic medications, for example, procainamide or amiodarone, might be utilized to control or keep a quick pulse. In the event that the heart rate does not come back to ordinary with restorative treatment, specialists may utilize a kind of treatment called electrical cardioversion (shock).

The long haul treatment for WPW disorder is all the time catheter removal. This methodology includes embedding a tube (catheter) into a vein through a little slice close to the crotch up to the heart zone. At the point when the tip achieves the heart, the little zone that is bringing on the quick heart rate is demolished utilizing an uncommon kind of vitality called radiofrequency or by solidifying it (cryoablation) [96-101].

Open heart surgery to smolder or stop the additional pathway may likewise give a perpetual cure to WPW disorder. By and large, this methodology is done just on the off chance that you require heart surgery for different reasons.

Complications may include:

 Complications of surgery

 Heart failure

 Reduced blood pressure (caused by rapid heart rate)

 Side effects of medicines

The most extreme type of a quick pulse is ventricular fibrillation (VF), which may quickly prompt stun or demise. It can once in a while happen in individuals with WPW, especially on the off chance that they additionally have atrial fibrillation (AF), which is another sort of anomalous heart mood [102-104]. This sort of quick pulse requires crisis treatment and a technique called cardioversion.

References