What is Wolff-Parkinson syndrome (WPW)?

Wolff-Parkinson-White (WPW) syndrome is a condition that causes the heart to beat abnormally fast for periods. You may feel scared when you are told that you have a problem with your heart but usually WPW syndrome is rarely serious. WPW syndrome can be life-threatening sometimes when it occurs alongside an irregular heartbeat called atrial fibrillation. This is however rare and treatment can eliminate any risk.

What is Wolff-Parkinson-White Syndrome (WPW)?

Wolf-Parkinson-White syndrome is a condition generally present at birth and hence is called a congenital condition. A person with WPW syndrome has an extra pathway for signals to travel between the upper and lower chambers of the heart. Resultantly, they have a fast heartbeat (tachycardia).

WPW syndrome is quite rare and causes fast heart rate problems. It is also called preexcitation syndrome.

Symptoms of WPW

It is not possible to say how often the rapid heart rate will occur. That depends on the person’s age. Some people have the episodes rarely while some have them once or twice a week. It can be suddenly triggered by strenuous exercise or drinking excessive alcohol or caffeine. The symptoms are very mild and often this condition is diagnosed when a heart test is done for some other reason. People with this condition may feel any of the following symptoms:

• Heartbeat of greater than 100 beats per minute
• Chest pain or tightness of the chest
• Dizziness and light-headedness
• Fainting
• Palpitations
• Shortness of breath
• A pounding or fluttering heartbeat
• Fatigue
• Anxiety

In infants, you may see symptoms such as blue or grey skin, lips or nails, restlessness and irritability, rapid breathing, and poor eating.

Causes of WPW

To understand what causes WPW syndrome, it must be understood that when the heart beats, the muscular walls contract (tighten and squeeze) to force blood out and into the body. They then relax, allowing the heart to fill with blood again. This contraction and relaxation is controlled by electrical signals.

When people have WPW syndrome, there is an extra electrical connection in the heart, which allows electrical signals to bypass the usual route and form a short circuit. This results in signals traveling round and round in a loop, causing the heart to beat very fast.

The extra electrical connection is caused by a strand of heart muscle that grows when the unborn baby is developing in the mother’s womb. Doctors are not clear why this happens. It occurs randomly in some babies while in some cases, it runs in families. The extra pathway can also cause the heart signals to travel backward causing uncoordinated heart rhythm.

Diagnosis of WPW

A doctor may want to first assess the symptoms that you have. They may order an electrocardiogram (ECG) and recommend you to a cardiologist. The ECG test records your heart’s rhythm and electrical activity. Small discs called electrodes are stuck to your arms, legs, and chest and connected by wires to an ECG machine. It will record the tiny electrical signals produced by your heart every time it beats. For normal people, the heart rate is 60 to 100 beats per minute in adults. In children, newborns, and infants, it is under 150 beats per minute.

A test called electrophysiologic study (EPS) is done using catheters that are placed in the heart. This can help identify the location of the extra electrical pathway.

Treatment Options

In several people, the episodes of abnormal heart activity associated with WPW syndrome do not last long and are harmless. They settle down without treatment. If your symptoms are mild and occur occasionally, you may not need treatment but will have to be monitored regularly.

Should your cardiologist recommend treatment, it could be of two types. One could be to stop episodes when they occur and the other could be to prevent episodes from happening in the future. Let us look at each of them.

Stopping an episode

There are three treatments and techniques to stop episodes when they occur:

• Vagal manoeuvres: This technique is used to stimulate the nerve that slows down the electrical signals in your heart. An example could be the “Valsalva manoeuvre” where you hold your nose, close your mouth and exhale hard while straining as though you would in the toilet.
• Medication: If vagal manoeuvres don’t help you, you may be given an injection of medicine such as adenosine. This medicine blocks the abnormal electrical signals in your heart.
• Cardioversion: A kind of electric shock therapy that jolts the heart back to the normal rhythm. If any of the other treatments, do not work, this can be done in a hospital.

Preventing further episodes

There are various ways to prevent further episodes:

• Lifestyle changes: In certain people, things like excessive alcohol or strenuous exercise may trigger these episodes. If so, the cardiologist may advise you to make changes.
• Catheter ablation: It is a procedure that involves inserting a tube (catheter) into a vein through a small cut near the groin, going all the way up to the heart area. When the tip reaches the heart, the area that is causing the fast heart rate is destroyed using an energy called radiofrequency or by freezing it (cryoablation). This is done as part of an electrophysiologic study. It is effective in 95% of cases.
• Medication: It is possible that you may be prescribed daily tablets of amiodarone which can help prevent episodes and slow done the electrical impulses in your heart.

Living with WPW

With treatment, people with WPW syndrome can enjoy life to the fullest and have a normal life expectancy. However, if left untreated, serious complications can develop especially if you have other heart conditions. Sudden cardiac death is rare in people with WPW syndrome. Once definitive therapy is performed, the prognosis is excellent.

It is good to avoid tobacco, smoking, caffeine, alcohol, and cocaine. Anything that triggers your condition like strenuous exercise may have to be avoided. If you have only mild symptoms, you may not need any major treatment except for regular check-ups. However, if you have symptoms such as fainting because of the condition, you may not be able to drive a car for instance.

It may be a good idea to keep a diary to record the episodes that you have. It is also important to manage your blood pressure and maintain a healthy blood pressure. It is also important to eat healthy, nutritious food. It is important to also maintain a healthy weight by staying physically active.

Conclusion

Several reasons can cause a fast heartbeat. If you feel uneasy, it is important to get a diagnosis and care. Several times, cases are diagnosed in healthy adults. It can be a scar; however, with treatment, most people can live a healthy life even if they have WPW syndrome.

Frequently Asked Questions

1. What is WPW syndrome?

It is a congenital heart condition that is caused by an extra electrical pathway in the heart, leading to a rapid heart rate.

2. What are the symptoms of WPW syndrome?

Symptoms are chest pain or tightness of the chest, light-headedness, dizziness, fainting, palpitations, and shortness of breath. Symptoms can start at any age but usually start in the teens or early 20s.

3. How is WPW syndrome diagnosed?

Your doctor will ask for the symptoms, perform a physical exam, and listen to the heartbeat. They may order a test like an electrocardiogram.

4. How is WPW syndrome treated?

Various treatments are possible. You may be advised lifestyle changes, medication, and other treatments. A catheter or radiofrequency ablation is a common treatment. It used a catheter to destroy the tissue causing the problem.

5. What is the outlook for WPW syndrome?

With treatment, a person with WPW syndrome can live a normal, healthy life. However, if left untreated, serious complications can develop especially if you have other heart conditions. Sudden cardiac death is rare in people with WPW syndrome. Once definitive therapy is performed, the prognosis is excellent.