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Wolff-Parkinson-White (WPW) Syndrome

By

L. Brent Mitchell

, MD, Libin Cardiovascular Institute of Alberta, University of Calgary

Reviewed/Revised Jan 2023
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Wolff-Parkinson-White syndrome is a disorder in which an extra electrical connection between the atria and the ventricles is present at birth. People may have episodes of a very rapid heartbeat.

  • Most people have awareness of heart beats (palpitations), and some feel weak or short of breath.

  • Electrocardiography is used to make the diagnosis.

  • Usually, episodes can be stopped by maneuvers that stimulate the vagus nerve, which slows the heart rate.

Wolff-Parkinson-White syndrome is the most common of several disorders that involve an extra (accessory) electrical pathway between the atria and the ventricles. (Such disorders may produce atrioventricular reciprocating supraventricular tachycardias Paroxysmal Supraventricular Tachycardia (SVT, PSVT) Paroxysmal supraventricular tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles... read more .) This extra pathway makes fast abnormal heart rhythms (arrhythmias) more likely to occur.

The abnormal pathway that causes Wolff-Parkinson-White syndrome is present at birth, but the arrhythmias it causes usually become apparent only during the teens or early twenties. However, arrhythmias may occur during the first year of life or not until after age 60.

The Conduction System
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Symptoms of WPW Syndrome

When infants develop arrhythmias due to this syndrome, they may become short of breath or lethargic, stop eating well, or have rapid, visible pulsations of the chest. Heart failure may develop.

Typically, when teenagers or people in their early 20s have an arrhythmia due to this syndrome, they experience it as an episode of palpitations Palpitations Palpitations are the awareness of heartbeats. The sensation may feel like pounding, fluttering, racing, or skipping beats. Other symptoms—for example, chest discomfort or shortness of breath—may... read more that begins suddenly, often during exercise. The episode may last for only a few seconds or may persist for several hours. For most people, the very fast heart rate is uncomfortable and distressing. A few people faint Fainting Light-headedness (near syncope) is a sense that one is about to faint. Fainting (syncope) is a sudden, brief loss of consciousness during which the person falls to the ground or slumps in a... read more .

In older people, episodes of paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome tend to cause more symptoms, such as fainting, shortness of breath, and chest pain.

Atrial fibrillation and Wolff-Parkinson-White syndrome

Atrial fibrillation Atrial Fibrillation and Atrial Flutter Atrial fibrillation and atrial flutter are very fast electrical discharge patterns that make the atria (upper chambers of the heart) contract very rapidly, with some of the electrical impulses... read more may be particularly dangerous for people with Wolff-Parkinson-White syndrome. The extra pathway can conduct the rapid impulses to the ventricles at a much faster rate than the normal pathway (through the atrioventricular node) can. The result is an extremely fast ventricular rate that may be life threatening. Not only is the heart very inefficient when it beats so rapidly, but this extremely fast heart rate may also progress to ventricular fibrillation Ventricular Fibrillation Ventricular fibrillation is a potentially fatal, uncoordinated series of very rapid, ineffective contractions of the ventricles (lower chambers of the heart) caused by many chaotic electrical... read more Ventricular Fibrillation , which is fatal unless treated immediately.

Diagnosis of WPW Syndrome

  • Electrocardiography

Because Wolff-Parkinson-White syndrome changes the pattern of electrical activation in the heart, it can be diagnosed using electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless medical test that measures the heart’s electrical impulses. During an ECG, the heart's electrical impulses are measured, amplified, and... read more Electrocardiography (ECG), which records the electrical activity of the heart.

Treatment of WPW Syndrome

  • Maneuvers and drugs to convert heart rhythm

  • Sometimes ablation

  • Straining as if having a difficult bowel movement

  • Rubbing the neck just below the angle of the jaw (which stimulates a sensitive area on the carotid artery called the carotid sinus)

  • Plunging the face into a bowl of ice-cold water

These maneuvers are most effective when they are used shortly after the arrhythmia starts.

When these maneuvers are ineffective, drugs such as verapamil, diltiazem, or adenosine are usually given intravenously to stop the arrhythmia. Antiarrhythmic drugs may then be continued indefinitely to prevent episodes of a fast heart rate (see table ).

In infants and children younger than 10 years, digoxin may be given to suppress episodes of paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome. However, adults with the syndrome should not take digoxin because it can facilitate conduction by the extra pathway and increase the risk that atrial fibrillation will degenerate into ventricular fibrillation. For this reason, digoxin is usually stopped before people with this syndrome reach puberty.

Ablation

Destruction of the extra conduction pathway by catheter ablation Destroying Abnormal Heart Tissue (Ablation) There are many causes of abnormal heart rhythms (arrhythmias). Some arrhythmias are harmless and do not need treatment. Sometimes arrhythmias stop on their own or with changes in lifestyle,... read more (delivery of energy using radiowaves, laser pulses, or high-voltage electrical current or freezing with cold through a catheter inserted in the heart) is successful in more than 95% of people. The risk of death during the procedure is less than 1 in 1,000. Ablation is particularly useful for young people who might otherwise have to take antiarrhythmic drugs for a lifetime.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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