Wolff-Parkinson-White (WPW) syndrome

Date Updated: 01/27/2022

Overview

In Wolff-Parkinson-White (WPW) syndrome, an extra signaling pathway between the heart's upper and lower chambers causes a fast heartbeat (tachycardia). WPW syndrome is a heart condition present at birth (congenital heart defect). It is fairly rare.

The episodes of fast heartbeats seen in WPW syndrome usually aren't life-threatening, but serious heart problems can occur. Rarely, WPW syndrome may lead to sudden cardiac death in children and young adults.

Treatment of WPW syndrome may include special actions, medications, a shock to the heart (cardioversion) or a catheter procedure to stop the irregular heart rhythm (arrhythmia).

WPW syndrome may also be called preexcitation syndrome.

Symptoms

The most common sign of Wolff-Parkinson-White (WPW) syndrome is a heart rate greater than 100 beats a minute.

Episodes of a fast heart rate (tachycardia) can begin suddenly and may last a few seconds or several hours. Episodes can occur during exercise or while at rest.

Other signs and symptoms of WPW syndrome are related to the fast heart rate and underlying heart rhythm problem (arrhythmia). The most common arrhythmia seen with WPW syndrome is supraventricular tachycardia. Supraventricular tachycardia causes episodes of a fast, pounding heartbeat that begin and end abruptly. Some people with WPW syndrome also have a fast and chaotic heart rhythm problem called atrial fibrillation.

In general, signs and symptoms that may occur in people with WPW syndrome include:

A rapid, fluttering or pounding heartbeat (palpitations)
Chest pain
Difficulty breathing
Dizziness or lightheadedness
Fainting
Fatigue
Shortness of breath
Anxiety

Symptoms in infants

Signs and symptoms of WPW syndrome in infants can include:

Pale or faded skin color (pallor)
Blue or gray coloring to the skin, lips and nails (cyanosis)
Restlessness or irritability
Rapid breathing
Poor eating

Some people with an extra electrical pathway don't have signs or symptoms of a fast heartbeat. This condition is called Wolff-Parkinson-White (WPW) pattern. It's often discovered by chance during a heart test.

When to see a doctor

Many things can cause a fast heartbeat. It's important to get a prompt diagnosis and care. Sometimes a fast heartbeat, or heart rate, isn't a concern. For example, the heart rate may increase with exercise.

If you feel like your heart is beating too fast, make an appointment to see a health care provider.

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

Sensation of a fast or pounding heartbeat
Difficulty breathing
Chest pain

Causes

Wolff-Parkinson-White (WPW) syndrome is a type of heart problem present at birth (congenital heart defect). WPW syndrome may occur with other types of congenital heart disease, such as Ebstein anomaly.

Rarely, WPW syndrome is passed down through families (inherited). The inherited, or familial, type is associated with a thickened heart muscle. This is a form of hypertrophic cardiomyopathy.

To understand the causes of WPW syndrome, it may be helpful to know how the heart typically beats.

How does the heart beat?

The heart is made of four chambers — two upper chambers (atria) and two lower chambers (ventricles).

The heart's rhythm is controlled by a natural pacemaker (the sinus node) in the right upper chamber (atrium). The sinus node sends electrical signals that typically start each heartbeat. These electrical signals move across the atria, causing the heart muscles to squeeze (contract) and pump blood into the ventricles.

Next, the heart signals arrive at a cluster of cells called the AV node, where the signals slow down. This slight delay allows the ventricles to fill with blood. When the electrical signals reach the ventricles, the chambers contract and pump blood to the lungs or to the rest of the body.

In a typical heart, this heart signaling process usually goes smoothly, resulting in a resting heart rate of 60 to 100 beats a minute.

In WPW syndrome, an extra electrical pathway connects the upper and lower heart chambers, allowing heart signals to bypass the AV node. As a result, the heart signals don't slow down. The signals become excited, and the heart rate gets faster. The extra pathway can also cause heart signals to travel backward, causing an uncoordinated heart rhythm.

Complications

WPW syndrome has been linked to sudden cardiac death in children and young adults.

Diagnosis

If you have a fast heartbeat, your health care provider will likely recommend tests to check for WPW syndrome, such as:

Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. A health care provider can look for patterns among the heart signals that suggest an extra electrical pathway in the heart.
Holter monitor. This portable ECG device is worn for a day or more to record the heart's rate and rhythm during daily activities.
Event recorder. This wearable ECG device is used to detect infrequent arrhythmias. You press a button when symptoms occur. An event recorder is typically worn for up to 30 days or until you have an arrhythmia or symptoms.
Electrophysiological (EP) study. An EP study may be recommended to distinguish between WPW syndrome and WPW pattern. One or more thin, flexible tubes (catheters) are guided through a blood vessel, usually in the groin, to various spots in the heart. Sensors on the tips of the catheters record the heart's electrical patterns. An EP study allows a health care provider to see how electrical signals spread through the heart during each heartbeat.

Treatment

Treatment for Wolff-Parkinson-White (WPW) syndrome depends on the severity and frequency of symptoms and the type of heart rhythm problem (arrhythmia) causing the fast heart rate.

The goals of treatment are to slow a fast heart rate when it occurs and to prevent future episodes. Treatment options for a fast heart rate include:

Vagal maneuvers. Simple but specific actions such as coughing, bearing down as if having a bowel movement or putting an ice pack on the face can help slow down the heart rate. Your health care provider may ask you to perform these actions during an episode of a fast heartbeat. These actions affect the vagus nerve, which helps control the heartbeat.
Medications. If vagal maneuvers don't stop a fast heartbeat, you might need medications to control the heart rate and restore the heart rhythm. Medications may need to be given by IV.
Cardioversion. Paddles or patches on the chest are used to electrically shock the heart and help reset the heart rhythm. Cardioversion is typically used when vagal maneuvers and medications don't work.
Catheter ablation. In this procedure, the health care provider inserts a thin, flexible tube (catheter) through a blood vessel, usually in the groin, and guides it to the heart. Sometimes more than one catheter is used. Sensors on the tip of the catheter use heat (radiofrequency energy) to create tiny scars in the heart. The scar tissue permanently blocks faulty electrical signals, restoring a regular heartbeat. Catheter ablation doesn't require surgery to access the heart, but it may also be done at the same time as other heart surgeries.

People with an extra signaling pathway but no symptoms (WPW pattern) usually don't need treatment.

Lifestyle and home remedies

If you have Wolff-Parkinson-White (WPW) syndrome or episodes of a fast heart rate (tachycardia), your health care provider will likely recommend following a heart-healthy lifestyle. Take these steps:

Avoid caffeine or other stimulants.
Don't smoke.
Eat a healthy diet.
Get regular exercise.
Limit or avoid alcohol.
Maintain a healthy weight.
Manage emotional stress.

Preparing for an appointment

Here's some information to help you get ready for your appointment.

What you can do

When you make the medical appointment, ask if you need to do anything in advance, such as restrict your or your child's diet.

Write down the following information and take it with you to the appointment:

Your or your child's symptoms, including any that may seem unrelated to the heart, and when they began
All medications, vitamins or other supplements you or your child takes, including doses
Important medical details, including other diagnosed conditions
Key personal information, including any recent life changes or stressors
Questions to ask your health care provider

Questions to ask your doctor

For WPW syndrome, some basic questions to ask your health care provider include:

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

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

How severe are the symptoms?
How often does the fast heartbeat occur?
How long do episodes last?
Does anything, such as exercise, stress or caffeine, seem to trigger the episodes or make symptoms worse?
Is there a family history of tachycardia or heart disease?