Wolff-Parkinson-White
(WPW) syndrome
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 your
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?
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