Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
REVIEW 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]. Downloaded from http://europace.oxfordjournals.org/ by guest on April 16, 2014 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 Downloaded from http://europace.oxfordjournals.org/ by guest on April 16, 2014 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. Downloaded from http://europace.oxfordjournals.org/ by guest on April 16, 2014 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. Downloaded from http://europace.oxfordjournals.org/ by guest on April 16, 2014 Figure 6 Dirk Durrer, famous Dutch cardiologist, Professor B. Lüderitz