Wolff-Parkinson-White (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.