MOJ
eISSN: 2471-139X
Submit manuscript...
Mini Review Volume 10 Issue 1
WPW syndrome: review of literature
Jayesh Trivedi,1 
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Shail Jani,2 Sagar Solanki,2 Farhan Piprani,2 Hardik Chaudhary,2 Twinkle Rana2
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
1HOD and Professor in General Medicine, Gujarat Adani Institute of Medical Sciences, India
23rd Year Resident –General Medicine, Gujarat Adani Institute of Medical Sciences, India
Correspondence: Jayesh Trivedi, HOD and Professor in General Medicine, Gujarat Adani Institute of Medical Sciences, Gaims, Bhuj, India
Received: November 14, 2022 | Published: January 11, 2023
Citation: Trivedi J, Jani S, Solanki S, et al. WPW syndrome: review of literature. MOJ Anat Physio. 2023;10(1):1-2. DOI: 10.15406/mojap.2023.10.00327
Abstract
Wolff-Parkinson-White (WPW) disorder is a disorder where there is additional accessory electrical pathway in the heart. Wolff-Parkinson-White syndrome (WPW) is the commonest form of ventricular pre-excitation. Wolff-Parkinson-White syndrome is not rare in the emergency department. Its early recognition and prompt treatment gives fast restoration to sinus rhythm. Early refer to cardiologist for electrophysiological study is necessary for early diagnosis and needed intervention. The patient with the Wolff-Parkinson-White (WPW) ECG design has much in the same way as patients with different conditions, like, long-QT disorder and Brugada disorder, because in sinus rhythm electrocardiogram (ECG) is different as compared to tachyarrthymic status of the same patient another differential with WPW syndrome will be LGL syndrome where delta wave will be absent
Introduction
Electrical signs complete a specific pathway of the heart. This helps the heart beat regularly and prevents from having any additional thumps or pulsates happening too early. In individuals with WPW disorder, a portion of the heart's electrical signs have an accessory pathway. This may come up with a fast heart rate called supraventricular tachycardia.1 WPW syndrome is a congenital cardiac pre-excitation syndrome that comes from abnormal cardiac electrical conduction via an additional pathway that can result in symptomatic and life-threatening arrhythmias. The electrocardiographic (ECG) criteria of WPW pattern consist of a short PR interval and QRS with an initial slurring upstroke (“delta” wave) in the presence of sinus rhythm. The term WPW syndrome is reserved for an ECG pattern consistent with the above-described findings along with the coexistence of a tachyarrhythmia and clinical symptoms of tachycardia such as palpitations, episodic light-headedness, presyncope, syncope, or even cardiac arrest.2
It is important to differentiate it from another pre excitation syndrome like Lown-Ganong-Levine (LGL) syndrome, this may remain silent in some patients and during routine check-ups surprisingly it is found out.3
Etiology
It is a congenital accessory pathway being associated with certain congenital conditions like atrial septal defect, hypertrophic cardiomyopathy and Epstein’s anomaly. This pathway becomes important for orthodromic and antidromic conduction and circus phenomenon taking place during tachyarrhythmia’s resulting into life threatening conditions in a totally asymptomatic person.4
It may be asymptomatic or
Tachypnea, irritability, pallor, intolerance of feedings, evidence of congestive heart failure if the episode has been untreated for several hours, palpitation, dizziness or syncope, dyspnea, anxiety and sudden cardiac arrest will result.5 Physical examination may be important but at certain times it may not be diagnostic and congenital anomalies like Epstein’s, Atrial septal defect(ASD), Hypertrophic cardiomyopathy(HCM) have to must be kept in mind, diagnostic add will be proper ECG studies, 2D echo cardiography and electro physiological studies.6
In ECG there will be short PR interval (<120 ms), prolonged QRS complex (>120ms).
QRS morphology consists of slurred delta wave
It can be of two types: in type 1 there will be right bundle branch block pattern with delta wave are upright and in type 2 there will be left bundle branch block pattern with delta wave is negative in v1, v2, v3 and positive in v4, v,5 v6; this will be seen only during sinus rhythm, during atrial fibrillation the QRS width becomes normal and delta wave disappears and in such conditions p wave will be absent, so during emergencies any medical intervention to control the ventricular rate like diltiazem, verapamil or digoxin if tried can result into ventricular asystole so in emergency with hemodynamic instability mechanical or electrical cardioversion will be the treatment of choice.7 Electrophysiological studies will be important to identify the site and number of accessory pathways for radiofrequency ablation treatment.8
Here we will submit ECG of one of our research
Here patient presented with atrial fibrillation with fast ventricular rate.
After the rhythm was reverted with cardioversion the finding of WPW was identified, it was found to be type A “WPW”.
Echocardiography of the same patient at short axis LV apex shows hypertrophic cardiomyopathy (ASH).
Acknowledgments
None.
Conflicts of interest
None.
References
- Moorman A, Webb S, Brown NA, et al. Development of the heart: (1) formation of the cardiac chambers and arterial trunks. Heart. 2003;89(7):806–814.
- Fitzsimmons PJ, McWhirter PD, Peterson DW, et al. The natural history of Wolff–Parkinson–White syndrome in 228 military aviators: a long–term follow–up of 22 years. Am Heart J. 2001;142(3):530–536.
- Munger TM, Packer DL, Hammill SC, et al. A population study of the natural history of Wolff–Parkinson–White syndrome in Olmsted County, Minnesota, 1953–1989. Circulation. 1993;87(3):866–873.
- Hiller ALP. Are Cholinesterase Inhibitors Effective in Improving Balance in Parkinsons Disease?. J Neurol Disord. 2016:S2–002.
- Kataoka H, Ueno S. Frontal Assessment Battery and Falling Related with Freezing of Gait in Parkinsons Disease. Int J Phys Med Rehabil. 2016;4:335.
- Wang K, Asinger R, Hodges M. Electrocardiograms of Wolff–Parkinson–White syndrome simulating other conditions. Am Heart J. 1996;132(1 Pt 1):152–155.
- Rodriguez LM, Geller JC, Tse HF, et al. Acute results of transvenous cryoablation of supraventricular tachycardia (atrial fibrillation, atrial flutter, Wolff–Parkinson–White syndrome, atrioventricular nodal reentry tachycardia). J Cardiovasc Electrophysiol. 2002;13(11):1082–089.
- Holman WL, Kay GN, Plumb VJ, et al. Operative results after unsuccessful radiofrequency ablation for Wolff–Parkinson–White syndrome. Am J Cardiol. 1992;70(18):1490–1491.
- Zeilig G, Shiller AD. Advanced Technology to Enhance Rehabilitation Outcomes: Parkinson Disease. Int J Neurorehabilitation Eng. 2016;3:e124.
©2023 Trivedi, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.