Download WPW syndrome: the `Rosetta stone` of rhythmology. The history of

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Europace (2009) 11, 285–288
doi:10.1093/europace/eun353
WPW syndrome: the ‘Rosetta stone’ of
rhythmology. The history of the Rosetta stone
Berndt Lüderitz*
Department of Medicine and Cardiology, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany
Received 4 November 2008; accepted after revision 19 November 2008; online publish-ahead-of-print 7 January 2009
----------------------------------------------------------------------------------------------------------------------------------------------------------Keywords
Rosetta stone † History † WPW syndrome † Cardiac arrhythmias
All internists and cardiologists who are interested in rhythmology
probably know the famous metaphor by James in which he calls the
Wolff –Parkinson –White (WPW) syndrome ‘the Rosetta stone of
electrocardiography, since a full understanding of all its features
and their possible mechanisms encompasses many fundamentally
important principles’ (James1 cited by Ikram2). In fact, the WPW
syndrome, first described in the American Heart Journal by Wolff
et al. in 1930,3,4 opened the eyes of electrophysiologists worldwide
to the pathogenesis of tachycardic rhythm disorders on a supraventricular and ventricular level. This symptom complex is characterized by a double excitation of the heart chambers caused by
pre-excitation (antesystole) along existing accessory excitation
pathways bypassing the normal, i.e. orthodromic, AV conduction
pathway (Figure 1). The additional atrioventricular connection
fulfills the anatomic and functional requirements for circus
movement or re-entry. Clinically, this usually takes the form of
(supraventricular) re-entry tachycardia via the atrium, AV node,
ventricle, accessory bundle, atrium (Figure 2). Each case of
WPW is highly individual and can have a variety of manifestations.
Prior to the ‘discovery’ of the WPW syndrome, interpreting the
respective phenomena was akin to reading hieroglyphic characters;
thus a clear pathophysiological understanding and practical clinical
diagnosis were impossible. The epochal work by Wolff, Parkinson,
and White, which resulted in the electrophysiologically correct
interpretation of circus movements as the cause of tachycardic
rhythm disorders, can therefore indeed be compared to the
deciphering of hieroglyphic writing by Champollion in 1822 with
the aid of the Rosetta stone.
The Rosetta stone
Rosetta (today called Rashid), the place where the same-named
stone was found, is an old Egyptian seaport in the western Nile
delta (Figure 3). The Rosetta stone was discovered there in
1799. With the aid of this artefact, it was possible to decipher
the hieroglyphic system of writing. The Rosetta stone is a halfround stone stele with carved text in three types of script. This
text contributed decisively to the deciphering of the Egyptian
hieroglyphs (‘sacred engraved letters’). Today it is located in the
British Museum in London. The stone is 114.4 cm high, 72.3 cm
wide, and 27.9 cm thick; it weighs 762 kg and consists of dark-gray
granodiorite—the hardest type of basalt. It dates from 196 BC and
contains a carved decree of the council of Egyptian priests.
However, the entire stele is heavily weathered; the entire upperleft corner has been chipped off, and other large text passages
are also missing. Therefore, around two-thirds of the hieroglyphic
text were lost.
This text—a priestly decree honouring King Ptolemy Epiphanes—was written in three different scripts, enabling three
population groups to read the text (Figure 4); namely the priests
in Egyptian hieroglyphs (hieratic script since 2400 BC), the
administration in Egyptian in Demotic script (demos ¼ people),
* Corresponding author. Tel: þ49 228 287 11904, Fax: þ49 228 287 11905, Email: [email protected]
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2009. For permissions please email: [email protected].
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Prior to the ‘discovery’ of the Wolff–Parkinson –White syndrome, interpreting the respective phenomena was akin to reading hieroglyphic
characters; thus a clear pathophysiological understanding and practical clinical diagnosis were impossible. The epochal work by Wolff,
Parkinson, and White, which resulted in the electrophysiologically correct interpretation of circus movements as the cause of tachycardic
rhythm disorders, can therefore indeed be compared to the deciphering of hieroglyphic writing by Champollion in 1822 with the aid of the
Rosetta stone. After intensive archaeological and graphological examinations by the Society of Antiquaries, the Rosetta stone finally made its
way to the British Museum, where it can still be viewed and admired today.
286
B. Lüderitz
so-called delta wave. Original image from Am Heart J 1930;5:685 (reproduced with kind permission).
i.e. the language used for daily purposes in old Egypt (~600 - 470
BC), and the Greek rulers over Egypt in ancient Greek, written in
Greek capital letters.
During the Egyptian expedition of Napoleon (1798–1801), in the
course of setting up a camp (Kâit Bey ¼ Rosetta Fort), French lieutenant Pierre François Xavier Bouchard found the stone on 15 July
1799, while working on the fortification of Fort St Julien, 4 km
from the city of Rosetta in the Nile delta. Scientists who accompanied
Napoleon on his expedition closely examined the stone.
During the war between France and Britain, Napoleon invaded
Egypt. From Egypt, he wanted to conquer India, the richest
colony governed by Britain and thus bring the British Empire
to a fall. While Bonaparte landed in Egypt, conquered
Alexandria, and started the march to the south, British admiral
Sir Horatio Nelson crossed the eastern Mediterranean Sea. In
August 1798, the Battle of the Nile was fought near Abukir
(20 km north-east of Alexandria), where the French fleet lay
at anchor. The French armada, which previously had brought
Napoleon’s expedition army to the land of the pyramids, was
defeated by the British navy under Admiral Nelson. Thus the
British recaptured the command of the Mediterranean Sea. Six
years later Nelson died in the Battle of Trafalgar (1805), in
which Napoleon’s naval forces were defeated and the British
fleet gained unrestricted rule over the world’s oceans. This was
the beginning of the end of Napoleon’s reign.
After the French had been defeated in Egypt, they had to relinquish the Rosetta stone to the British in 1801, together with other
antiques. In the spring of 1801, when Cairo was being threatened
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Figure 1 The PR interval is reduced and is significantly below 0.1 s. The prolonged QRS complex is caused by the pre-excitation with the
287
WPW syndrome
Figure 2 Simplified representation of the various possible
Figure 4 The Rosetta stone as it looks today.
Figure 3 Map segment (Nile delta) with topography of the city
of Rosetta (today called Rashid).
by military operations under the leadership of Sir Ralph
Abercromby, academic scholars who participated in the French
expedition took the Rosetta stone to Alexandria to keep it safe.
According to the unfortunate capitulation treaty, the stone had
to be handed over to General Hutchinson; however, it initially
remained hidden among the luggage of French General Menou.
In the end, the Rosetta stone nevertheless got into the hands of
Colonel Turner (who was later promoted to Major General),
Figure 5 In 1822, 31-year-old Jean François Champollion
achieved a breakthrough in the decipherment of the hieroglyphs
when he successfully identified the names of the Pharaohs
Ramses and Thutmose. Champollion had a remarkable scientific
career that came to an early end upon his death at the age of
41. Champollion described the hieroglyphs as a script that contains pictorial, symbolic, and phonetic elements in the same
text, the same phrase, and even within the same word.
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accessory conduction pathways in cases with Wolff–Parkinson–
White syndrome; K, bundle of Kent; J, bundle of James; M,
Mahaim fibres. The hatched area represents the atrioventricular
border.
288
of Cardiology and Clinical Physiology at the University of
Amsterdam, pioneer of clinical electrophysiology. A park carrying
his name was created in Amsterdam in his honour.
who shipped the precious find to Portsmouth in February 1802, on
board of the HMS L’Egyptienne. After intensive archaeological and
graphological examinations by the Society of Antiquaries, the
Rosetta stone finally made its way to the British Museum, where
it can still be viewed and admired today.
In 1822, with the aid of the Rosetta stone, Jean-François
Champollion succeeded in deciphering the Demotic script and
found the key to the hieratic script and the hieroglyphs (Figure 5).
Credit for deciphering the ancient script also belongs to Silvestre
de Sacy, Johan David Åkerblad from Sweden and Thomas Young
from Britain.
Wolff – Parkinson –White
syndrome
The famous Dutch cardiologist Dirk Durrer (1918–84) and his
school drew the clinical consequences that resulted from the
Figure 7 Metal sculpture in the ‘Durrer Park’ that visualizes
dual atrioventricular conduction and gives an impression of the
cause of re-entry tachycardia (Minerva Plein, Amsterdam;
author in the background).
discovery of the WPW syndrome, the Rosetta stone of rhythmology. In his honour, a park has been created in Amsterdam (Figure 6)
at Minerva Plein, close to his old apartment at Rubensstraat 27.
The Durrer Park houses a huge metal sculpture that symbolizes
the dual atrioventricular conduction and gives an impression of
the re-entry excitation (circus movement) that causes tachycardic
rhythm disturbances (Figure 7).
Conflict of interest: none declared.
References
1. James TN. The Wolff –Parkinson–White syndrome. Ann Intern Med 1969;71:
399 –405.
2. Ikram H. Direct demonstration of pure infranodal preexcitation (Mahaim conduction) by A-V nodal and His bundle electrography. Angiology 1977;28:376.
3. Wolff L, Parkinson J, White PD. Bundle branch block with short P-R interval in
healthy young people prone to paroxysmal tachycardia. Am Heart J 1930;5:
683 –704.
4. Lüderitz B. Profiles in Cardiac Pacing and Electrophysiology. Oxford: Blackwell Futura,
2005.
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Figure 6 Dirk Durrer, famous Dutch cardiologist, Professor
B. Lüderitz