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.
(See also Overview of Abnormal Heart Rhythms and see Paroxysmal Supraventricular Tachycardia.)
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.) 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.
Symptoms of WPW Syndrome
Wolff-Parkinson-White syndrome is a common cause of paroxysmal supraventricular tachycardia. Very rarely, this syndrome results in a very fast, life-threatening heart rate during atrial fibrillation.
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 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.
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 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, 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 (ECG), which records the electrical activity of the heart.
Treatment of WPW Syndrome
Maneuvers and drugs to convert heart rhythm
Sometimes ablation
Episodes of paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome can often be stopped by one of several maneuvers that stimulate the vagus nerve and thus slow the heart rate. Maneuvers include
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.
Some Drugs Used to Treat Arrhythmias).
Ablation
Destruction of the extra conduction pathway by catheter ablation (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.
American Heart Association: Arrhythmia: Information to help people understand their risks of arrhythmias as well as information on diagnosis and treatment
