Wolff-Parkinson-White Syndrome (WPW): Symptoms, Causes, and Treatment

Wolff-Parkinson-White (WPW) syndrome is a condition that causes the heart to beat abnormally fast (tachycardia) for periods. It is also called preexcitation syndrome. 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.

Symptoms

It is impossible to say how often the rapid heart rate will occur. That depends on the person’s age. Some people have episodes rarely, while some have them once or twice a week. It can be suddenly triggered by strenuous exercise, 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 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

To grasp the cause of WPW syndrome, it’s important to know that the heart’s muscular walls tighten with each beat, propelling blood throughout the body. The walls then loosen, enabling the heart to refill with blood. This contraction and relaxation is controlled by electrical signals.

In individuals with WPW syndrome, an additional electrical pathway in the heart lets signals bypass the normal route, creating a short circuit. This results in signals traveling round and round in a loop, causing the heart to beat very fast.

The extra electrical pathway forms from a strand of heart muscle that develops while the baby is growing in the 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 an uncoordinated heart rhythm.

Diagnosis

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

An electrophysiologic study (EPS) is a test performed by placing catheters inside 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 you will have to be monitored regularly.

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

Stop an Episode

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

• Vagal manoeuvres: This method stimulates the nerve responsible for slowing the electrical signals in your heart. One example is the “Valsalva manoeuvre,” which involves pinching your nose, sealing your mouth, and forcefully exhaling as if straining during a bowel movement.
• 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.

Controlling 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: This procedure involves guiding a thin tube (catheter) through a small incision near the groin into a vein, leading it up to the heart. Once the catheter’s tip reaches the heart, the area responsible for the rapid heartbeat is treated using either radiofrequency energy or freezing (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 down 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 rarely occurs in individuals 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 to keep your body healthy. Additionally, you should eat healthy, nutritious food. Furthermore, 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