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Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White syndrome (WPW) is a type of abnormal heartbeat. If you have WPW, you may have episodes of tachycardia, when your heart beats very rapidly. WPW affects between one and three of every 1,000 people worldwide.

Electrical signals going through your heart in an organized way control your heartbeat. This allows blood to pass from the upper chambers of your heart (the atria) to the lower chambers of your heart (the ventricles), and to then travel throughout your body.

Normally, a structure in your heart called the sinoatrial node regulates how electricity passes from the upper chambers of your heart to the lower chambers. The sinoatrial node keeps your heartbeat at about 60 to 100 beats a minute. When you have WPW, you are born with an extra pathway that allows electrical signals to bypass the sinoatrial node. This can result in a very rapid heart rate — 200 beats per minute or more.

Symptoms

With WPW, you may not have any episodes of tachycardia for many years. Symptoms may also start and stop suddenly and occur at any age. Typical symptoms include:

  • Shortness of breath

  • A pounding in your chest

  • Dizziness

  • Passing out

Who's at risk

WPW affects both men and women. In most cases, the cause of WPW isn’t known, but doctors have identified mutations in a gene that may be responsible for WPW. A small number of people may be at risk because they inherited this gene from a parent. WPW is a common cause of tachycardia in China, and you may be at increased risk if you are of Chinese descent.

Diagnosis

If you have symptoms of tachycardia that come and go, your doctor will do a test called an electrocardiogram, or ECG. An ECG measures the electrical activity in your heart and your heart rate. If you are not having symptoms at the time of your ECG, results may look normal. Other tests may include:

  • Conducting an ECG as you walk on a treadmill

  • Wearing a type of recorder, called a Holter monitor, that takes an ECG over 24 hours

  • Wearing a type of recorder, called an event recorder, that samples your heart rate over several days

  • Electrophysiologic testing, a hospital procedure that involves threading catheters into your heart through a vein in your thigh

Treatment

You may not need any treatment if you do not have symptoms, or have infrequent symptoms. Also, symptoms sometimes go away as people get older. If you do need treatment, there are a number of options:

  • You may be able to stop an episode of tachycardia by massaging your neck, coughing, or bearing down like you are having a bowel movement. This is called a Valsalva maneuver.

  • You may be able to take medication to stop or prevent tachycardia.

  • If medication and the Valsalva maneuver do not work, you may need to go to the hospital for cardioversion. This procedure restores your heartbeat to a normal rhythm, by passing an electric current through your chest into your heart.

  • If you are having frequent or uncontrolled episodes of tachycardia, you may have a surgical procedure called radiofrequency ablation. Low-voltage, high-frequency electrical energy interrupts the extra pathway in your heart. Your doctor threads a catheter into your heart through a vein in your thigh. The treatment cures WPW about 95 percent of the time.

Complications

WPW is not a dangerous disease for most people. You can manage or correct the condition with treatment. The biggest risk is for sudden death from a heart attack, which tachycardia can cause. However, this is extremely rare, occurring in less than one-half of 1 percent of cases.

How to manage or live with WPW

There is no way to prevent WPW, but you can prevent complications by learning as much as you can about the disease and working closely with your cardiologist to find the best treatment. Ask your doctor to teach you how to do a Valsalva maneuver.

Here are helpful lifestyle suggestions:

  • Don't smoke.

  • Work with your doctor to keep conditions like high cholesterol and high blood pressure under control.

  • Eat a heart-healthy diet.

  • Maintain a healthy weight.

  • Get regular exercise.

  • Tell your doctor know right away if you have symptoms of WPW.