How WPW Syndrome Manifests itself
WPW syndrome is caused by a congenital malformation that affects the heart’s electrical conduction system.
The impulse of cardiac contraction originates in an electrical control unit, the atrial sinus node, and then spreads throughout the heart muscle through a sophisticated electrical transmission system.
This implant, in the WPW syndrome, has a defect: there is the presence of a double electrical cable where there should be only one; these electrical wires can also be short-circuited with normal wires and give rise to very violent and sudden arrhythmias.
However, these arrhythmias are not caused, as in people without the condition, by stress or fatigue, but by a true internal electrical blackout in the heart.
How many people are affected by WPW syndrome?
WPW pathology has an estimated incidence of around 0.3-0.4% in the entire world population, and within this percentage, in 1 in 1,000 cases, it can also result in sudden death.
In the vast majority of cases, arrhythmias are very violent but tolerated.
The patient can get help and access appropriate care; in 1 in 1,000 people, however, the onset is death.
This population incidence is actually a controversial figure.
It is not so easy to document this problem in the population: this is the most up-to-date data we have available; for a given figure, it would be necessary to map the general population with an electrocardiogram.
Diagnosis of WPW pathology
WPW syndrome can be identified with a simple electrocardiogram.
The malformation in the electrical system of the heart can be seen very clearly.
It routinely happens, therefore, that people reach the diagnosis due to an occasional finding, or because the patient, faced with a first tachycardia, goes to the specialist.
Caution for those who play sports
Despite this ease of diagnosis, it is a particularly delicate problem and even more so in those who practice sports.
The heart subjected to stress and adrenaline in sports settings, in the presence of this defect, can have extremely more severe arrhythmias than the general population.
This is the reason why sports medicine requires the performance of an electrocardiogram.
It is necessary to be sure that this problem is not present, and if it is found, extensive cardiological investigations are inevitably required to study the danger of this anomaly.
How the dangerousness of the WPW pathology is established
Once the abnormality has been found on the electrocardiogram, the question remains: can it be harmless in an asymptomatic person, or can it be dangerous even if it has not given symptoms so far?
Therefore, a decision must be made whether to remove it with an operation or to tell the patient that he can live with it safely.
The tests that are carried out are capable of establishing the danger of this installation by defining its proarrhythmic characteristics.
The main test to establish the level of danger of the condition is the electrophysiological study.
It is performed on an inpatient basis and consists of introducing electrical microprobes, electrocatheters, into a vein in the body, generally the femoral vein, under local anesthesia.
It is not a particularly invasive investigation, nor is it dangerous: through these probes we can study all those electrical characteristics of the structure, defining its dangerousness and then indicating to the patient whether it is convenient to eliminate this double thread or if he can live. with him safely.
How to treat WPW syndrome
There are 2 main approaches to treating WPW syndrome:
- surgical, with ablative treatment;
The surgical approach: the ablative cure
In most cases, the approach to this pathology must be surgical.
The removal of this electrical wire was once done through an extremely invasive cardio-surgical approach: it involved doing a thoracotomy surgery, therefore with all the problems associated with a long course.
Today, however, by the same route used to study the problem, a microprobe with electrothermal capabilities capable of inducing microthoracotomy cautery is introduced.
The wire is literally electrocoagulated by losing the ability to conduct the pulse, thus making the abnormality disappear from the conventional electrocardiogram.
This is a technique that has been used for years and has a success rate of 95 to 99%, a very high rate, with 2 days of hospitalization and 6 to 10 hours of bed rest.
Once treated, the heart heals.
So, the patient runs more risks by not treating this syndrome, encountering the possibility of developing arrhythmias, the severity of which cannot be defined without further studies.
The pharmacological approach
There are pharmacological treatments for the treatment of WPW disease.
However, these are treatments that fail to induce a stable recovery of the patient.
They are drugs that must be taken daily for prolonged periods.
For these reasons, therefore, at the level of international guidelines, ablative care intervention should be considered first class as a therapeutic recommendation compared to pharmacological therapy.