Wolff-Parkinson-White Syndrome

What is Wolff-Parkinson-White syndrome?

WPW is a condition in which the heart beats abnormally fast due to electricity incorrectly traveling between two different pathways in the heart. In the normal heart, there is only a single pathway that conducts electricity through the heart to coordinate the beating. In WPW, there is a second pathway that the electricity can be conducted through.

It is possible to have two conduction pathways and not develop WPW. However, in those who develop the condition, symptoms include a fluttering in the chest, dizziness or lightheadedness, a loss of consciousness, chest pain, trouble breathing, and, in rare cases, sudden cardiac death.

Treatments include methods to normalize the heart rate, removing the second pathway through procedures, as well as medication to limit possible adverse effects.

You should visit your primary care physician soon to confirm the diagnosis and discuss treatment options.

Wolff-Parkinson-White syndrome symptoms

Symptoms usually first appear in teens or people in their 20s. People who have an extra conduction pathway ("pre-excitation") but have not developed WPS will not have any symptoms. However, if they develop WPW, they can experience symptoms that include the following.

Main symptoms

The main symptoms of WPW include:

• A fluttering sensation in the chest: This occurs because the heart is beating faster than normal, and in some cases can have an irregular rhythm (arrhythmia).
• Dizziness or lightheadedness: This occurs because the heart is beating too fast to effectively pump blood to the brain.
• Losing consciousness: In severe cases, people with WPW can pass out if not enough blood is getting to their brain.

Other symptoms

Other symptoms that can also occur in some people with WPW include:

• Chest pain or tightness: This can occur because the heart is beating abnormally, or if the heart is not getting enough blood.
• Trouble breathing: This can occur if the heart is beating too fast to pump effectively and fluid backs up into the lungs.
• Sudden cardiac death: In rare cases, people with WPW can suddenly die because of a problem with their heart. This is known as "sudden cardiac death." This usually occurs if the heart develops a very abnormal rhythm and is not treated in time.

Wolff-Parkinson-White syndrome causes

Having the second pathway in the heart for electricity to be conducted is also known as "pre-excitation" or "Wolff-Parkinson-White pattern." It affects one to three people out of every 1,000. In certain circumstances, such as after receiving medications that affect the heart rhythm, the electricity can form the troublesome loop between the two pathways and go back and forth. People of any age, including infants, can have this condition. The specific cause of WPW is not known, but it has been associated with some risk factors.

Risk factors for developing WPW

Risk factors for developing WPW include:

• Having a family member with pre-excitation or WPW: This is because mutations in certain genes can cause WPW.
• Congenital heart defect: Some people who are born with a specific heart defect known as "Ebstein's anomaly" can develop WPW. This can occur if their mother was taking certain medications while she was pregnant.

Treatment options and prevention

WPW is a chronic condition that usually cannot be completely cured. Therefore, treatments focus on controlling and reducing the frequency of symptoms. Treatments can be used for both reducing short-term symptoms and reducing the frequency of symptoms in the long term.

Short-term treatments

Short-term treatments for WPW include the following, and are usually administered sequentially in this order until symptoms are resolved:

• Maneuvers to slow the heart: These include massaging the sides of your neck or asking you to bear down to stimulate the vagus nerve. These maneuvers can slow the heart and can sometimes bring the heart back to a normal rhythm.
• Medications to slow the heart: These include adenosine (Adenocard), verapamil (Calan), procainamide (Procan), or propranolol (Inderal), among others. The specific medication will vary depending on the type of abnormal rhythm you have. These medications can usually be stopped once the heart rhythm becomes normal.
• Shock to the heart: Physicians can apply a shock to your heart (electrical cardioversion) to convert to a normal rhythm.

Long-term treatments

Long-term treatments to reduce the frequency of symptoms are listed below, and are prioritized in the following order:

• Catheter ablation: Physicians may recommend ablation of the extra conducting pathway for people with WPW, regardless of whether symptoms are present yet. This involves inserting a catheter or thin tube through the blood vessels to get to the heart, where electricity is used to destroy the area of the heart with the extra conducting pathway. This will prevent the electricity from looping between the two pathways and will reduce your chance of developing WPW again.
• Surgery: For people who do not respond to catheter ablation, a physician can instead recommend surgery to remove the extra conducting pathway. Surgery can be associated with more risks than catheter ablation but has very high success rates.
• Medications: For people who don't want to undergo catheter ablation or are not good candidates, a physician may recommend taking certain medications long-term to reduce the risk of developing abnormal heart rhythms that cause symptoms. These include flecainide (Tambocor), propafenone (Rythmol), or amiodarone (Cordarone).

When to seek further consultation

You should seek medical attention if you experience symptoms or have a family history of WPW.

If you develop any symptoms of WPW

You should see your physician right away or consider going to the emergency room if you develop symptoms such as a fluttering sensation in the chest, chest pain, shortness of breath, lightheadedness, or dizziness. Your physician can order testing to see if you have WPW or another abnormal heart rhythm and can offer the appropriate treatment.