Wolff - Parkinson-White syndrome

Cause pathogenesis of atrial ventricular impulse so that the whole or a part of the ventricular early excitement, or ventricular the impulse so that the whole atrium, or a certain part of atrial early excitement, known as Wolff - Parkinson-White syndrome. The most common type is preexcitation ventricular preexcitation accompanied by accessory pathways (accessory atrinventri cular Pathways) is kent beam. These pathways from the atrium-like band composed almost exists in the atrioventricular ring around any location. Wolff - Parkiason-White Syndrome (W.P.W syndrome) 1 ECG words apply to a pre-excitation with a performance of paroxysmal tachycardia patients. In addition, there are three types of abnormal passageway. Atrioventricular nodal pathways beam, James fiber connecting atrium and atrioventricular forged or in the bundle. Lown - Ganong-Levine syndrome that fall in this category. Two Mahaim fiber, including atrioventricular to ventricular fibers called Guitar Room fiber, and the beam originated from Heathrow or bundle branch. attached to the ventricular muscle fibers called fiber branch Room, Room Guitar connected PR interval may be normal or reduced, and QRS wave of integration, branch connecting rooms have normal PR interval and fixed the abnormal QRS complex. Road adjacent to the above four see figure 3 -3-14. Clinical manifestations preexcitation itself is not cause symptoms, but often leads to rapid ventricular arrhythmias on the attack. The room paroxysmal tachycardia and general paroxysmal supraventricular tachycardia similar. Occurrence of atrial fibrillation or atrial flutter, ventricular rate can be quickly reached 220 -360 per minute meeting, which led to the shock, Heart failure, and even sudden death. ECG accessory pathways antegrade conduction arise : ① PR interval shortening ( "0.12 seconds); ② QRS ramus of the initial rough net (delta waves) and ③ QRS widened the typical ECG changes. This graphic representatives through bypass roads and through Hayes-Purkinje system ventricular depolarization integration, deformation degree by systems in addition to the corresponding role in the decision. By chest leads QRS morphology, WPW can be divided into type A and type-B. A pre-shock and the QRS complex in the chest leads upwards (Figure 3-3-15A) B-type pre-shock and the QRS complex in lead V1 lower, with the Left Alliance upwards. (Figure 3-3-15B). Wolff - Parkinson-White syndrome with paroxysmal supraventricular tachycardia attack, often along the normal impulse conduction system antegrade conduction, by bypass roads conduction and thus the performance of QRS morphology normal. About 5% of the patients showed that the graphic opposite, namely through the next antegrade conduction Road, Hayes-Purkinje system conduction, Ventricular entirely bypass the exception of a very attracted wide QRS complex tachycardia. Atrial fibrillation and atrial flutter is also common in the Wolff - Parkinson-White syndrome patients. Because there is no bypass roads as the atrioventricular node conduction slow down the characteristics of ventricular rate at this time may soon, or even give rise to ventricular fibrillation. Suspected of Wolff - Parkinson-White syndrome in patients, the electrophysiological examination aimed at : ① further confirmed diagnosis; ② Road adjacent to determine the origin; ③ prove Road adjacent to the role of arrhythmias; ④ determine Road adjacent to the refractory period; ⑤ and choose the correct treatment measures. Treatment of ventricular preexcitation patients may be asymptomatic or, occasionally associated with tachyarrhythmias without obvious symptoms. These patients do not need electrophysiological examination or treatment. Patients with frequent seizures and tachyarrhythmias cause obvious symptoms, should be given treatment. If electrocardiogram QRS said normal, P-R interval rules, the heart rate of about 200 times / hours should consider reciprocating tachycardia, and the general treatment of supraventricular tachycardia same choice of verapamil and treatmants ATP or digitalis, if abnormal QRS and the R-R interval significantly irregular, and should be suspected preexcitation with atrial fibrillation, should choose treatmants Procaine amide, or quinidine and propranolol combination, and banned verapamil, digitalis and ATP, because after three bypass roads can be shortened refractory period and accelerate bypass conduction, even ventricular fibrillation. Room for the attack on the regular rate, symptoms, OK to clear electrophysiological Road adjacent to the site of electricity ablation. Radiofrequency ablation, or surgical treatment.