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Wolff-Parkinson-White (WPW) syndrome

Overview

In Wolff-Parkinson-White (WPW) syndrome, an extra electrical pathway between your heart's upper and lower chambers causes a rapid heartbeat. The extra pathway is present at birth and fairly rare.

The episodes of fast heartbeats usually aren't life-threatening, but serious heart problems can occur. Treatment can stop or prevent episodes of fast heartbeats. A catheter-based procedure (ablation) can permanently correct the heart rhythm problems.

Most people with an extra electrical pathway experience no fast heartbeat. This condition, called Wolff-Parkinson-White pattern, is discovered only by chance during a heart exam. Although WPW pattern is often harmless, doctors might recommend further evaluation before children with WPW pattern participate in high-intensity sports.

Symptoms

People of all ages, including infants, can experience the symptoms related to WPW.

Symptoms of WPW syndrome are the result of a fast heart rate. They most often appear for the first time in people in their teens or 20s. Common symptoms of WPW syndrome include:

  • Sensation of rapid, fluttering or pounding heartbeats (palpitations)
  • Dizziness or lightheadedness
  • Shortness of breath
  • Fainting
  • Fatigue
  • Anxiety

An episode of a very fast heartbeat can begin suddenly and last for a few seconds or several hours. Episodes can occur during exercise or while at rest. Caffeine or other stimulants and alcohol may be a trigger for some people.

Over time, symptoms of WPW may disappear in as many as 25 percent of people who experience them.

Symptoms in more-serious cases

About 10 to 30 percent of people with WPW syndrome occasionally experience a type of irregular heartbeat known as atrial fibrillation. In these people WPW signs and symptoms may include:

  • Chest pain
  • Chest tightness
  • Difficulty breathing
  • Fainting

Symptoms in infants

Signs and symptoms in infants with WPW syndrome may include:

  • Ashen color
  • Restlessness or irritability
  • Rapid breathing
  • Poor eating

When to see a doctor

A number of conditions can cause irregular heartbeat (arrhythmia). It's important to get a prompt, accurate diagnosis and appropriate care. See your doctor if you or your child experiences any symptoms associated with WPW syndrome.

Call 911 or your local emergency number if you experience any of the following symptoms for more than a few minutes:

  • Rapid or irregular heartbeat
  • Difficulty breathing
  • Chest pain

Causes

The extra electrical pathway in your heart that causes a rapid heartbeat is present at birth. An abnormal gene is the cause in a small percentage of people with WPW. The syndrome also is associated with some forms of congenital heart disease, such as Ebstein's anomaly.

Otherwise, little is known about why the extra pathway develops. WPW is more common in males than in females.

Normal heart electrical system

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by a mass of tissue in the right atrium (sinus node). The sinus node produces electrical impulses that generate each heartbeat.

These electrical impulses travel across the atria, causing muscle contractions that pump blood into the ventricles. The electrical impulses then arrive at a cluster of cells called the atrioventricular (AV) node — usually the only pathway for signals to travel from the atria to the ventricles. The AV node slows the electrical signal before sending it to the ventricles.

This slight delay allows the ventricles to fill with blood. When electrical impulses reach the ventricles, muscle contractions pump blood to the lungs and the rest of the body.

Abnormal electrical system in WPW

In WPW syndrome, an extra electrical pathway connects the atria and ventricles, allowing electrical impulses to bypass the AV node. When the electrical impulses use this detour through the heart, the ventricles are activated too early.

The extra electrical pathway can cause two major types of rhythm disturbances:

  • Looped electrical impulses. In WPW, the heart's electrical impulses travel down either the normal or the extra pathway and up the other one, creating a complete electrical loop of signals. This condition (AV reentrant tachycardia) sends impulses to the ventricles at a very rapid rate. As a result, the ventricles pump very quickly, causing rapid heartbeat.
  • Disorganized electrical impulses. If electrical impulses don't begin correctly in the right atrium, they may travel across the atria in a disorganized way, causing atrial fibrillation. The disorganized signals and the extra pathway of WPW also can cause the ventricles to beat faster. As a result, the ventricles don't have time to fill with blood and don't pump enough blood to the body.
Normal heartbeat

In a normal heart rhythm, a tiny cluster of cells at the sinus node sends out an electrical signal. The signal then travels through the atria to the atrioventricular (AV) node and then passes into the ventricles, causing them to contract and pump out blood.

Normal heartbeat

In a normal heart rhythm, a tiny cluster of cells at the sinus node sends out an electrical signal. The signal then travels through the atria to the atrioventricular (AV) node and then passes into the ventricles, causing them to contract and pump out blood.

Wolff-Parkinson-White (WPW) syndrome

In Wolff-Parkinson-White (WPW) syndrome, an extra electrical pathway between your heart's upper chambers and lower chambers causes a rapid heartbeat.

Complications

For many people, WPW syndrome doesn't cause significant problems. But complications can occur, and it's not always possible to know your risk of serious heart-related events. If the disorder is untreated, and particularly if you have other heart conditions, you may experience:

  • Fainting spells
  • Fast heartbeats
  • Rarely, sudden death

Diagnosis

Your doctor will likely recommend heart tests to diagnose WPW syndrome, such as:

  • Electrocardiogram (ECG). Small sensors attached to your chest and arms record electrical signals as they travel through your heart. Your doctor can look for patterns among these signals that indicate the presence of an extra electrical pathway in your heart.
  • Portable ECG. Using a portable ECG device at home provides more information about your heart rate. A Holter monitor records your heart activity for 24 hours. An event recorder monitors heart activity when you experience symptoms of a fast heart rate.
  • Electrophysiological testing. Thin, flexible tubes (catheters) tipped with electrodes are threaded through your blood vessels to various spots in your heart. The electrodes can precisely map the spread of electrical impulses during each heartbeat and identify an extra electrical pathway.

Treatment

Treatment depends on several factors, including the severity and frequency of your symptoms.

If you have the WPW pathway but don't have any symptoms, you probably won't need treatment. If treatment is needed, the goal is to slow a fast heart rate when it occurs and to prevent future episodes.

Treatment options include:

  • Vagal maneuvers. These simple physical movements — which include coughing, bearing down as if you are having a bowel movement and putting an ice pack on your face — affect a nerve that helps regulate your heartbeat (vagus nerve). Your doctor may recommend performing vagal maneuvers to help slow a rapid heartbeat when it occurs.
  • Medications. If vagal maneuvers don't stop the fast heartbeat, you may need an injection of an anti-arrhythmic medication. Your doctor also may recommend a medication that can slow the heart rate.
  • Cardioversion. Your doctor may use paddles or patches on your chest to electrically shock your heart and help restore a normal rhythm. Cardioversion is typically used when maneuvers and medications aren't effective.
  • Radiofrequency catheter ablation. Thin, flexible tubes (catheters) are threaded through blood vessels to your heart. Electrodes at the catheter tips are heated to destroy (ablate) the extra electrical pathway causing your condition. Radiofrequency ablation permanently corrects the heart-rhythm problems in most people with WPW syndrome.

What you can do

  • Write down your symptoms, including any that may seem unrelated to your heart.
  • Make a list of all your medications, vitamins or supplements.
  • Write down your key medical information, including other diagnosed conditions.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Write down a list of questions to ask your doctor.

Questions to ask your doctor

  • What's the most likely cause of my symptoms?
  • What kinds of tests do I need?
  • What treatments can help?
  • What risks does my heart condition create?
  • How often will I need follow-up appointments?
  • Do I need to restrict my activities?
  • How will other conditions that I have or medications I take affect my heart problem?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. Your doctor might ask:

  • When did you first begin experiencing symptoms? How severe are they?
  • How often have you experienced a fast heartbeat?
  • How long have the episodes lasted?
  • Does anything such as exercise, stress or caffeine seem to trigger or worsen the episodes?
  • Do you have a family history of heart disease?

Last updated: November 17th, 2016

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