Wolff Parkinson White syndrome
Wolff Parkinson White syndrome is a heart disorder resulting from the existence of an abnormal and additional electrical pathway between the atria and the lower chambers (ventricles) of the heart; a congenital condition often causing tachycardia.
- Palpitations, shortness of breath and weakness are the common symptoms.
- Diagnosis can be confirmed by electrocardiography ECG).
- Certain manual procedures help stop the abnormal heart rhythm by stimulating the vagus nerve that is responsible for slowing down the heart rate.
Wolff Parkinson White syndrome is a congenital disorder of the heart characterized by the presence of an abnormal electrical pathway which transmits the electrical impulses from the atria to the ventricles, in addition to the normal route which is through the atrioventricular node. The disorders resulting from this extra connection are collectively termed atrioventricular reciprocating supraventricular tachycardia, and Wolff Parkinson White syndrome is one of the most common causes.
This extra (accessory) pathway predisposes a person to abnormally fast heart rhythms or arrhythmias. Though present at birth, the Wolff Parkinson White syndromemay remain asymptomatic until much later in life. Usually, teenagers and young adults start developing arrhythmias due to this condition but it may start as early as in the first year or even as late as after sixty years of age.
Symptoms
Wolff Parkinson White syndrome is one of the most common heart conditions precipitating the rapid heart rhythm called paroxysmal supraventricular tachycardia, which may become fatal when accompanied by atrial fibrillation.
Listlessness, refusal to eat well, shortness of breath and very fast, outwardly visible, pulsing of the chest are the usual symptoms observed, when arrhythmia due to this syndrome develops in infancy. It can cause heart failure in infants.
In young adults and teenagers, a sudden appearance of palpitations, usually during strenuous exercise is the first symptom of arrhythmia due to WPW. It may subside in a few seconds or may continue for several hours, often causing distress and discomfort. Fainting is also not uncommon.
Shortness of breath, chest pain (angina) and fainting are the usual symptoms of paroxysmal supraventricular tachycardia resulting from WPW, in older people and the symptoms often seem to worsen with age.
Atrial Fibrillation and Wolff Parkinson White Syndrome: If a person with Wolff-Parkinson-White syndrome develops atrial fibrillation, the extra electrical pathway between the atria and the ventricles conducts the abnormally fast electrical impulses much faster to the ventricles than the atrioventricular node, which normally slows down conduction of impulses. This faster transmission may result in a potentially fatal, extremely rapid ventricular rhythm that may lead to ventricular fibrillation which requires immediate medical intervention.
Diagnosis
Since the electrical activity of the heart gets recorded during electrocardiography (ECG), it is the ideal diagnostic test for Wolff-Parkinson-White syndrome which results from the abnormally patterned electrical activity of the heart.
Treatment
The manual stimulation of the vagus nerve through various procedures, if done immediately after the onset of the abnormal rhythm, can often stop the paroxysmal supraventricular tachycardia resulting from Wolff Parkinson White syndrome. When the manual stimulation fails to stop the arrhythmia, intravenous administration of adenosine or verapamil may be given to stop it. To prevent further occurrence, the drugs may be prescribed for continued use.
Digoxin is the drug of choice for children under10 years, but it is contraindicated in adults due to the increased risk of atrial fibrillation precipitating a potentially fatal ventricular fibrillation, due to the action of the drug. Before children with Wolff-Parkinson-White syndrome reach puberty, digoxin is discontinued, as it may enhance the electrical conduction between the atria and the ventricles via the abnormal pathway, increasing the chance of ventricular fibrillation.
A minimally invasive procedure called radiofrequency ablation, for the selective destruction of the extra electrical pathway, is a highly successful solution to the problem and it carries only a minimal risk rate of 0.1%. In this procedure, a catheter fitted with electrodes deliver high frequency energy to the targeted area of the heart, destroying only that area. For young people especially, it is a viable alternative to a lifetime of antiarrhythmic medication.
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Yasser Elnahas
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