Wolff-Parkinson-White (WPW) syndrome
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Wolff–Parkinson–White syndrome (WPW) is a cardiac condition that manifests in individuals who are born with a specific congenital heart defect. This condition changes the normal route that electrical impulses, or signals, take through the heart. Individuals with WPW syndrome possess an additional signal pathway in their hearts. When signals travel an unusual route, the heart is at risk of beating too fast. WPW syndrome is also known as preexcitation syndrome.
In WPW syndrome, the heart has an extra or accessory route. Electrical impulses use the alternate path instead of the conventional one. When electrical impulses use the other path, they pass through the heart too quickly. This results in a rapid heartbeat (a type of abnormal rhythm known as supraventricular tachycardia).
While the episodes of rapid heartbeats observed in individuals with WPW syndrome are typically not life–threatening, there is a possibility of serious cardiac complications. In rare cases, WPW syndrome can lead to sudden cardiac death, particularly among children and young adults. WPW syndrome treatment may include special actions, drugs, cardioversion, or a catheter operation.
Symptoms
Symptoms of Wolff–Parkinson–White syndrome differ. A heart rate of more than 100 beats per minute is the most common symptom of WPW syndrome. Tachycardia or a rapid heart rate can occur unexpectedly and linger for a few seconds or several hours. Episodes of rapid heartbeats in individuals with WPW syndrome can manifest during physical activity or even at rest.
Additional signs and symptoms of WPW syndrome are associated with the accelerated heart rate and the underlying arrhythmia. Supraventricular tachycardia is the most prevalent arrhythmia associated with WPW syndrome. It is characterized by rapid, pounding heartbeats that begin and end abruptly. Atrial fibrillation, a fast and chaotic heart rhythm, is also among the symptoms of WPW syndrome.
Common signs and symptoms of WPW syndrome include:
- Heart palpitations that can last a few seconds or several hours
- Chest discomfort
- Difficulty breathing issues
- Dyspnea, or shortness of breath
- Feeling dizzy or lightheaded
- Fainting
- Fatigue
- Anxiety
Infants with WPW syndrome may specifically exhibit a variety of signs and symptoms such as pale or fading skin color, cyanosis, poor eating, quick breathing, or irritability.
There are cases where individuals with an extra electrical pathway do not exhibit any noticeable signs or symptoms of a rapid heartbeat. This particular condition is referred to as Wolff–Parkinson–White (WPW) pattern, which is often incidentally detected during a heart examination or test.
If one experiences a rapid heartbeat or other signs of Wolff–Parkinson–White syndrome, contact a healthcare provider for proper diagnosis and treatment. A rapid heartbeat can be caused by a variety of factors. A quick heartbeat, or heart rate, isn’t always a cause for alarm. However, consultation is still highly recommended.
If you experience any of the following symptoms persistently for several minutes, it is crucial to immediately contact your local emergency number:
- Sensation of a rapid or pounding heartbeat
- Difficulty breathing
- Chest pain
Causes
In a normal heart, electrical impulses follow the same pathway through the heart repeatedly. In WPW syndrome, an extra electrical route joins the upper and lower heart chambers, allowing heart signals to bypass the AV node. As a result, heart signals do not slow down. The signals get more stimulated, and the heart rate increases. The presence of the extra pathway can also lead to the retrograde conduction of heart signals, resulting in an uncoordinated heart rhythm.
The cause why this happens is still unknown. WPW syndrome is thought to have a potential familial predisposition, suggesting the existence of a family history, while in other cases, the condition may arise without a known cause. WPW syndrome can occur with other types of congenital cardiac disease, such as Ebstein anomaly.
Researchers have found some changes in specific genes that may induce a kind of WPW syndrome known as familial Wolff–Parkinson–White syndrome. Or some may have an inherited condition known as hypertrophic cardiomyopathy, characterized by thickened heart muscle that can be linked to WPW syndrome.
Diagnosis
The diagnosis of WPW syndrome often requires discussing the symptoms, doing a physical examination, and ordering several tests.
Initial changes in the heartbeat may be noticed during the physical exam. Several tests may be required to provide the doctor more information about the heart rate, rhythm, and the presence of any conduction problems. These tests include:
- Electrocardiogram (ECG or EKG): An EKG test is a quick approach to collect information to help check electrical activity of the heart. It monitors, tracks, and records the electrical activity of the heart using temporary electrodes on the chest and limbs. Signal patterns can aid in the diagnosis of an extra electrical pathway in the heart. This is a quick and painless examination that can help diagnose WPW syndrome.
- Holter monitor: This device continuously records the heart’s rate and rhythm for 24 hours or more. This is a portable ECG equipment that can be carried in a pocket or worn on a belt or shoulder strap during regular daily activities.
- Event recorder: An event recorder is usually worn for up to 30 days, or until symptoms appear. Patients will need to press the record button whenever they feel symptoms and it only records for a few minutes at a time. This ECG wearable device detects infrequent arrhythmias.
- Electrophysiological (EP) study: This is a thorough examination of the heart’s electrical activity. Cardiovascular catheters and computers are used to obtain electrocardiogram (EKG) tracings and electrical measurements from inside the heart. Sensors on the catheter tips record the electrical patterns of the heart. An EP study enables the healthcare provider to view how electrical signals travel through the heart during each beating. This test can differentiate between WPW syndrome and WPW pattern.
Treatment
Treatment for Wolff–Parkinson–White syndrome varies. People with no symptoms, or those with WPW pattern are usually not treated. Those who are frequently suffering from rapid heartbeat with symptoms such as dizziness or passing out, several treatments may be recommended.
The treatment aims to lower a rapid heart rate when it happens and to avoid repeat episodes. The degree and frequency of symptoms, as well as the type of arrhythmia causing the rapid heart rate, all affect the treatment for WPW.
Treatment options for WPW include:
- Vagal maneuvers: The healthcare provider usually instructs to perform certain measures during a fast heartbeat episode. Specific maneuvers, such as coughing, bearing down as if having a bowel movement, or applying an ice pack to the face influence the vagus nerve, which regulates or slows down the heartbeat.
- Medications: Medications are often prescribed if vagal maneuvers fail to work. This can aid in regulating the heart rate and restoring normal heart rhythm.
- Cardioversion: When vagal techniques and medicines fail, cardioversion is recommended. Cardioversion helps to stop an irregular heartbeat and restore normal heart rhythm if there are irregular rhythms such as SVT. Paddles or patches on the chest are used to shock the heart and assist restore its rhythm.
- Catheter ablation: During the procedure, a catheter is inserted via a blood vessel, commonly in the groin, and is guided to the heart. More than one catheter is sometimes utilized during the procedure. Small scars in the heart is done using heat (radiofrequency energy). Scar tissue permanently blocks incorrect electrical signals, allowing the heart to beat normally again. Catheter ablation does not require surgery to access the heart, but it can be performed with other heart procedures.
