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Wolff (Wolfe)-Parkinson-White (WPW)
Wolff (Wolfe)-Parkinson-White (WPW) results from an additional
electrical connection between the atria (upper chambers of the heart)
and the ventricles (lower chambers of the heart). This extra or accessory
electrical pathway is present in approximately 1.5 per 1,000 people. It
runs in families in less than 1% of cases. In the majority of cases it
is completely silent and only detected on a routine ECG. In a small proportion
of patients the extra electrical pathway allows conduction of the electrical
pathway generating an electrical circuit which produces symptoms.
Symptoms and clinical picture
Palpitations are the main symptoms due to an abnormally
rapid heart rate. They can occur at any time and some patients learn to
control them by holding their breath for prolonged periods. In many instances
the palpitations remain until they are terminated by medical therapy in
the accident and emergency department.
When the patient is experiencing palpitations the heart
rate is usually in excess of 150 beats per minute. When the patient has
no symptoms there is nothing to find on examination.
Most patients tolerate this well but some experience very troublesome
palpitations, light-headedness and blackouts. A very small minority of
patients may die suddenly from ventricular fibrillation. WPW is a very
rare cause of sudden death.
The ECG usually shows two abnormalities when the patient is free of
symptoms ? a short PR interval and a delta wave.
The ideal treatment in patients with symptoms is to destroy the extra
electrical pathway, a procedure termed radio frequency ablation. This
is done by passing a wire into the heart via the large artery (femoral
artery) in the leg. The abnormal pathway is located by electrical stimulation
and destroyed by passing a high current through it. This takes approximately
2-3 hours and requires one night in hospital.
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