Wolf-Parkinson-White syndrome, clinical case

Abstract

Introduction: Wolf-Parkinson- White syndrome (WPW) is a type of ventricular pre-excitation realized through an abnormal connection between the atria and the ventricles, known as Kent bundle, prior to nodo-hisian depolarization. The disease has a genetic substrate, it develops mainly in men, involving a high risk of ventricular arrhythmias and sudden death. The incidence of WPW syndrome is 4 cases per 100,000 persons, while the prevalence is 1-3 cases per 1000 pers. Male/female ratio is 1.5-2/1. About 50 % of patients with WPW develop tachyarrhythmias; the frequency of supraventricular tachycardia paroxysms increases from 10% at the age of 20-39 to 36% over 60 years. The management of the disease depends on the paroxysms frequency and the types of arrhythmia. We present the clinical case of a man with WPW syndrome who develops recurrent paroxysmal supraventricular tachycardia, treated since 1997. Clinical case: Patient L., 52 years old, admitted to the Cardiology Department nr.3 of PMSI MCH „Holy Trinity”. Diagnose: WPW syndrome. Paroxysmal supraventricular tachycardia. HF I NYHA. The complaints presented on onset: palpitations, inspiratory dyspnea, fatigue. History of the disease: diagnosed in 1997, when he developed a paroxysm of supraventricular tachycardia. Arrhythmia paroxysms were the cause of repeated hospitalizations - 2-3 times/year while being on antiarrhythmic therapy with Amiodarone. On physical examination: The overall condition of medium severity. Clean, normal-colored skin. Vesicular breath sounds, rales missing. Rhythmic heart sounds with HR 170 b/min, BP 120/70 mmHg. ECG conclusion: WPW syndrome. Supraventricular tachycardia with HR 170 b/min. Normal heart electrical axis. LV repolarization disorders. EchoCG: moderate dilatation o f LA and RA. Induration of the aortic walls. LV hypertrophy, left ventricular contractile function is preserved. Laboratory analysis without deviation from the norm. Treatment: Amiodarone 800mg-intravenously in perfusion until paroxysm cessation, with subsequent administration after schema. Conclusions: Patient L., 52 years with WPW syndrome who develops an arrhythmia paroxysm was hospitalized for its cessation and reassessment of treatment strategy. Pharmacological cardioversion had positive effect. The prognosis is favorable for the patient due to rare paroxysms of supraventricular tachycardias with a good response to drug treatment.