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"Child`s Health" 2 (45) 2013

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WPW syndrome and the phenomenon in children (review)

Authors: Nagornaya N.V., Pshenichnaya Ye. V., Parshin S.A., Donetsk National Medical University of M. Gorky

Categories: Cardiology, Pediatrics/Neonatology

Sections: Specialist manual

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В статье представлены данные об истории открытия и изучения синдрома и феномена Wolff — Parkinson — White (WPW). Рассмотрены особенности анатомии и электрофизиологии дополнительных путей проведения, механизмы возникновения приступов пароксизмальной атриовентрикулярной реципрокной тахикардии при синдроме WPW. Показана роль стандартной ЭКГ, методов топического анализа дополнительных атриовентрикулярных соединений и неинвазивного электрофизиологического исследования в диагностике данной патологии.

У статті наведені дані про історію відкриття та вивчення синдрому та феномену Wolf — Parkinson — White (WPW). Розглянуто особливості анатомії та електрофізіології додаткових шляхів проведення, механізми виникнення нападів пароксизмальної атріовентрикулярної реципрокної тахікардії при синдромі WPW. Показана роль стандартної ЕКГ, методів топічного аналізу додаткових атріовентрикулярних з’єднань і неінвазивного електрофізіологічного дослідження в діагностиці даної патології.

The article deals with the data on the history of the discovery and study of the phenomenon and syndrome Wolff — Parkinson — White (WPW). The features of the anatomy and electrophysiology of additional ways, mechanisms of attacks of atrioventricular reentrant tachycardia in WPW syndrome are considered. The role of the standard ECG, methods for topical analysis of additional atrioventricular connections and non-invasive electrophysiological studies in the diagnosis of this disease is shown.


синдром и феномен WPW, дети.

синдром і феномен WPW, діти.

WPW syndrome and phenomenon, children.

Tachyarrhythmias are the most common and clinically significant cardiac arrhythmias in childhood. The prevalence of paroxysmal supraventricular tachycardia in the general population is 2.25 per 1,000 people are diagnosed each year and 35 new for every 100,000 population.

Today, many aspects of the pathogenesis of supraventricular tachycardia, the options for its clinical and electrophysiological course, prognostic value, risk of life-threatening conditions, the management of patients remain poorly understood. According to Salerno J.C. et al., WPW syndrome refers to a disease with a risk of sudden cardiac death.

History of the Study Wolf-Parkinson-White syndrome (WPW) began April 2, 1928, when the teacher with attacks of palpitations came to Paul White. Assistant White P.D. Louis Wolf performed electrocardiography, which identified changes of the QRS and shortening interval PQ. Wolf L. and White P.D. with John Parkinson from London summarized 11 such cases, presenting them as a clinical and electrocardiographic syndrome, which is a "combination of atypical blockade leg, abnormally short PQ interval and paroxysmal tachycardia (also paroxysmal atrial fibrillation and atrial flutter) in young, healthy patients with normal hearts" in 1930.

Levin S.A. and Beenson R.B. proposed the term "syndrome Wolf-Parkinson-White - WPW», continued to date in clinical practice in 1941.

Several lines of reasoning suggest that defects in the annulus fibrosus may occur during normal cardiac development as the atria and ventricles become electrically isolated and the normal conduction system develops. Though these connections normally regress during development, their persistence may provide the basis for some forms of preexcitation. Not only are accessory AV connections more common early in development, but their increased occurrence in certain congenital cardiac lesions such as Ebstein's anomaly and 1-transposition of the great arteries reinforces the developmental basis for this disorder.

Among children with WPW syndrome boys are dominated, and their prevalence is more pronounced after 10 years. There are two main peaks of the debut of tachycardia: in the first year of life and at the age of 10-15 years.

The structure of all supraventricular tachycardias shares arrhythmias with additional atrioventricular connections reaches 54-75%. In this case, paroxysmal atrioventricular reciprocating tachycardia with WPW syndrome is manifested 39,4%, with hidden additional retrograde atrioventricular connections – 24,1%.

There are different versions of the anomalous additional ways. The most common additional atrioventricular connections in the free wall of the left atrioventricular groove and septum. In most patients, additional connections are made from the fibers of the working myocardium, does not have the properties of specialized conduction system of the heart.

There are different algorithms of topical diagnosis of additional atrioventricular connections. Gallagher J.J. et al. method allows to determine the location of the abnormal, depending on the morphology of the "delta-wave".

Transesophageal ECG play significant role in the diagnosis of WPW syndrome and phenomenon.

Electrophysiological methods have been used in cardiac pediatric practice in the early 70's of the XX century. The important property of transesophageal pacing is the possibility of multiple repetition of the study because of its noninvasive nature, low morbidity and low risk of complications.

Bakshene N.D. used transesophageal electrical stimulation of the heart in children, including newborns and infants, in order to determine the mechanisms of cardiac arrhythmias and the electrophysiological properties of the conducting system of the heart and detect life-threatening arrhythmias in 1986. Since that time, a new period of development of clinical electrophysiology has been started in pediatric cardiology.

So, the WPW syndrome is the actual problem of cardiology. Paroxysmal atrioventricular reciprocating tachycardia with this syndrome is rarely associated with risk of cardiac arrest, but, despite this, is one of the factors for the development of atrial fibrillation with subsequent transformation in the development of ventricular fibrillation and sudden cardiac death. However, there are still many questions and controversy regarding the clinical course of the phenomenon of WPW in children. Not the factors that influence the occurrence of spontaneous seizures tachycardia, no generally accepted indications for radiofrequency ablation, which is the subject of our future work.



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