If your doctor has told you that you have the Wolff-Parkinson-White (WPW short) do not fret because their problem has a solution.
This condition was first described in 1930 when doctors Louis Wolff, Sir John Parkinson and Paul D. White described several cases of patients with characteristic alterations in the electrocardiogram associated with recurrent episodes of tachycardia manifested as rapid heartbeat, dizziness and even loss of consciousness (syncope).
Since then, many achievements in the knowledge of the causes and treatment of this disorder.
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The Heart and Electrical:
The heart is a muscular organ that pumps blood continuously. It has 4 chambers, two on the left side and two on the right side. The upper chambers on each side, called atria, receive blood from the lungs and the rest of the body. The lower chambers on each side, called ventricles pump blood. The 4 cameras working together and coordinated to contract and pump blood that carries oxygen and nutrients to all body tissues.
The rhythmic contractions of the heart depend on the normal functioning of your electrical system that generates and conducts impulses through the heart (Figure 1 on page 5).
The sinus node, structure formed by a group of specialized cells located in the right atrium is where the electrical impulse normally begins. Functions as the natural pacemaker of the heart, giving the trend rate and frequency for each heartbeat.
This electrical activity spreads through the atria, causing them to contract and squeeze blood into the ventricles. From the atria, the electrical impulse reaches the atrioventricular node (AV node) that is located between the atria and ventricles, acting as a "toll" slows each impulse electric before allowing passage into the ventricles. Once there, it moves through pathways made of specialized muscle fibers that are divided into a network of smaller and smaller fibers that distribute the electrical impulse through both ventricles, causing them to contract and pump blood.
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What is Wolff Parkinson White Syndrome?
In WPW there is an abnormality in the heart's electrical system due to the occurrence of an abnormal connection between the atria and ventricle corresponding. This extra electrical pathway allows electrical signals to pass through it, rather than exclusively by the normal driving system, producing a kind of "electrical short" that leads to the appearance of tachycardias.
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How often presents the WPW?
The WPW occurs in approximately 1 in 10,000 people. However, the actual incidence is difficult to determine because many patients have very mild symptoms or no symptoms at all (asymptomatic). Others may spend several years without tachycardia.
Episodes of tachycardia associated with WPW can occur at any age but usually appear during the second or third decade of life.
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What are the most common symptoms?
When the heart contre very fast (tachycardia), the ventricles do not have enough time to fill with blood before the next contraction. The result is a decrease in the amount of blood in each heart beat sent to the brain and other organs. While the patient has no tachycardia remain without symptoms but once it appears, may have palpitations, dizziness, chest pain or chest tightness, fatigue, weakness, shortness of breath and in severe cases, unconsciousness.
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How is WPW diagnosed?
The first suspicion is obtained with the electrocardiogram (ECG) is a tracing of paper that records the electrical waves of the heart by placing electrodes on the skin. In patients with WPW appears wave "Delta" which is a characteristic alteration of this disease and is caused by the presence of electrical activity through abnormal accessory pathway. The ECG findings will be more or less evident depending on the amount of electric current reaches the ventricles through the accessory pathway. When the electrical activity is abundant through it, is very abnormal ECG and the easier to recognize. If, however, the current reaches the ventricles is primarily through the normal driving system, then the ECG changes are very subtle requiring a trained eye diagnosis. The ECG can change overnight in the same patient, depending on factors that allow varying conduction through the accessory pathway.
The presence of delta wave and other ECG changes should be accompanied by symptoms caused by episodes of tachycardia (usually documented in the ECC) to establish the diagnosis of WPW syndrome. While the patient has no symptoms (asymptomatic), we just say that you have ventricular preexcitation and WPW electrocardiographic pattern.
Patients with WPW are usually seen initially by a cardiologist, who promptly determine depending on particular case, if required evaluation by the electrophysiologist (cardiologist with special training and experience in electrical disorders of the heart).
Most of these patients will merit electrophysiological study or cardiac catheterization, which is a procedure to evaluate in depth the heart's electrical system to pinpoint the abnormal accessory pathway, evaluate conduction properties and the risks to which it is subjected the patient during tachycardias.
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What is the treatment of WPW?
Traditionally, patients with very infrequent episodes of tachycardia, are well tolerated and of short duration, usually no specific treatment is required just as those who have no symptoms. Recent studies suggest the electrophysiological catheterization in children between 5 and 12 asymptomatic WPW ECG pattern, but there is still no consensus on this issue and should expect the results of further investigations in larger populations of patients with these characteristics.
Others are treated with antiarrhythmic drugs to prevent tachycardia. These drugs should be administered and be monitored carefully and should generally be taken permanently.
Those in whom antiarrhythmic drug therapy is ineffective or produces undesirable side effects, and patients with very rapid tachycardia leading to dizziness or loss of consciousness, warrant conducting electrophysiological study or catheter ablation catheters and by energy RF. It is also recommended its implementation in patients with a family history of sudden death.
RF ablation is a first-line therapeutic resource use and increasingly to treat patients with WPW syndrome, because it allows the destruction of the accessory pathway and definitive cure in over 90% of cases with a low risk of complications. Thus, eliminating the possibility of tachycardia occur in the most unexpected times and the need to take medication on an ongoing basis which will have a direct impact on the quality of life by making it more active and productive. This aspect is of particular value especially in young patients.
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