What to Know About Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White (WPW) syndrome is a congenital condition characterized by episodes of tachycardia, or a rapid heartbeat. With treatment, it may be completely curable. WPW syndrome may also be called ventricular pre-excitation with arrhythmia. If a person does not have an arrhythmia, it is called WPW pattern.

Read on to learn more about Wolff-Parkinson-White syndrome, including its causes, symptoms, diagnosis, and treatment.

WPW syndrome results from a structural heart irregularity that is present from birth. People with the condition have an extra electrical connection in their hearts. Electrical signals control the heartbeat by causing the heart’s walls to contract and relax, sending blood to the rest of the body and filling up again.

In a typical heartbeat, the electrical signals begin in the upper chamber of the heart, then pass through a bundle of cells called the atrioventricular (AV) node. This node sites between the heart’s upper and lower chambers. The signals then travel down to the lower chambers, or the ventricles.

In WPW syndrome, the signals bypass the AV node by traveling through the extra electrical connection. This means that the signals reach the ventricles more quickly than usual. This may result in tachycardia, or a heartbeat that is faster than usual.

The exact cause of this heart abnormality is often unknown. Some cases result from mutations in the PRKAG2 gene, which provides the body with instructions on producing an enzyme that responds to cellular energy demands.

WPW syndrome typically develops in people with no family history of the condition. A subtype called familial WPW syndrome may be passed down from a parent to a child.

The classic symptom of WPW syndrome is having tachycardia episodes. These episodes may last from seconds to hours.

Tachycardia may cause additional symptoms, including:

• dizziness or lightheadedness
• chest pain
• shortness of breath
• fainting
• heart palpitations, or a sensation of pounding or fluttering in the chest

Not all people with WPW syndrome will develop symptoms.

To diagnose WPW syndrome, a doctor will begin by asking you about your symptoms. If they suspect WPW syndrome, they’ll order an electrocardiogram (EKG), which will allow them to evaluate your heart’s electrical activity.

WPW syndrome causes an atypical heart pattern that an EKG can detect. In some cases, your doctor may have you wear an ECG recorder that will record your heart over a period of a few days. You may also be asked to press a button on the device whenever you begin to experience symptoms consistent with a WPW syndrome episode.

Your doctor may order additional tests to identify potential underlying causes of the tachycardia. These tests can include:

• chest X-ray
• blood tests
• thyroid tests

Your doctor may also order cardiac testing to evaluate the effect of WPW syndrome on your heart. These tests can also determine if there is an increased risk of sudden cardiac death, which means that the heart is either not beating sufficiently to maintain life or is not beating at all. Cardiac tests may include:

• echocardiogram
• exercise stress test
• electrophysiology study

For people who are symptomatic, there are a few treatment methods that may help stop an episode.

Vagal maneuvers are techniques that can slow down the heart’s electrical signals. The Valsalva maneuver involves attempting to exhale against a closed airway. This means you will try to exhale for 10–15 seconds while pinching your nose shut and closing your mouth.

Another example of a vagal maneuver is the carotid sinus massage. For this maneuver, a medical professional will have you lie down and will press on your carotid artery, which is located on the side of your vocal cords just under the chin.

If vagal maneuvers are ineffective, certain medications may help prevent or stop episodes once they begin. Examples include:

• beta-blockers, which can reduce stress on the heart
• calcium channel blockers, which can lower blood pressure by relaxing the heart’s vessels
• anti-arrhythmic medications

In addition, certain medications can be administered intravenously, or through a vein, in an emergency medical setting:

• adenosine (Adenocard)
• procainamide (Pronestyl)
• ibutilide (Corvert)
• amiodarone (Cordarone)

If medications and vagal maneuvers are unsuccessful in relieving symptoms, doctors may perform a procedure called cardioversion. This involves sending an electrical shock to the heart to induce a normal heart rhythm.

Learn more about how doctors perform cardioversion.

Catheter ablation can be used to treat and potentially cure WPW syndrome. This procedure uses certain types of energy — like lasers, heat, or extreme cold — to destroy the atypical electrical connection causing the condition. Cather ablation is typically effective, benefitting affected individuals about 95% of the time.

This treatment procedure can also be considered for asymptomatic WPW patterns if doctors determine a person is at high risk for sudden cardiac death.

Learn more about how doctors perform catheter ablation.

The outlook for people with WPW syndrome has improved over the years with advancements in medications and ablation procedures. For some people, catheter ablation can even cure the condition completely.

Reporting any symptoms to your doctor and following their treatment plan is the best way to manage the condition and prevent complications.

In rare cases, WPW syndrome may cause sudden cardiac death.

In addition, people who experience fainting during an episode may be at risk for injuries due to falls.

There is currently no way to prevent WPW syndrome. Once it’s diagnosed, there are effective treatments available to prevent or stop episodes.

These are a few other common questions about WPW syndrome. Cardiologist Angela Ryan Lee, MD, FACC, reviewed the answers.

Not necessarily. While sudden cardiac death is a rare complication, treating WPW syndrome can help manage symptoms. Most people who receive treatment can expect to have a typical life expectancy.

Most people with WPW syndrome have no family history of the condition. One subtype, familial WPW syndrome, can be passed down from a parent to a child.

Researchers estimate that WPW syndrome affects around 0.1–0.3% of the population.

WPW syndrome is a congenital condition. It causes episodes of tachycardia that may result in dizziness, shortness of breath, and fainting. Because WPW syndrome can increase the risk of sudden cardiac death, an evaluation by a cardiologist is essential.

The condition is curable with catheter ablation. Vagal maneuvers and medications may also help manage symptoms.

Talk with your doctor about ways to manage WPW syndrome.