WPW Syndrome

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

Wolff-Parkinson-White (WPW) syndrome is one of several congenital disorders of the electrical system of the heart which leads to a rapid heartbeat called tachycardia.

This disorder is caused by an additional electrical pathway between the Atria, which is the heart’s upper chamber, and the Ventricles, which is the heart’s lower chambers.

There is no specific age group that is affected by this disorder as it can occur at any age including after birth, to which signs and symptoms of Wolff-Parkinson-White (WPW) syndrome will manifest, but most commonly initial symptoms appear from age 11 and 50.

Also, this is unusual disorder that only seen in 4 out of 100,000 people. Symptoms of Wolff-Parkinson-White (WPW) syndrome vary from non-life-threatening such as fast heartbeats to more severe symptoms such that of heart problems.

Immediate medical attention is needed for this disorder since there are available treatment that can stop or cause the fast heartbeat to normalize.

Also, an invasive procedure called catheter ablation can be performed to correct heart rhythm problems by removing or terminating faulty electrical pathways.

2 Symptoms

High heart rate is the main cause for the signs and symptoms of Wolff-Parkinson-White syndrome to arise. Early symptoms of the condition may present during teenager stage of at the age of 20's.

Basic symptoms of WPW syndrome are as follows:

  • sensation of rapid
  • fluttering or pounding heartbeats which is more popularly known as palpitations
  • dizziness
  • lightheadedness
  • fainting
  • easily tired or exhausted when engaged in physical activity such as exercise, and anxiety

People with WPW syndrome may suddenly encounter episode of unusually rapid heartbeat that can last for a few seconds to several hours.

Such episodes can be triggered by exercise and ingestion of caffeine or other stimulants. One-fourth or about 25 percent of the population of people with WPW would have their symptoms disappear through time.

In more severe cases, individuals with WPW may present with atrial fibrillation which is a type of abnormal irregular heartbeat and will show such symptoms as:

  • chest pain
  • chest tightness
  • difficulty breathing
  • and in rare cases does death happen

Infants may also develop WPW hence here are the symptoms that may appear, shortness of breath, lack of alertness or activity, poor eating, and fast heartbeats visible on the chest.

In the early stages of Wolff-Parkinson-White syndrome, the person will not show signs and symptoms as initially the increased heartbeat is not life-threatening and that it can only be detected through a heart exam.

However, if you start or your child has started experiencing signs and symptoms of WPW then immediate medical attention is necessary.

Also, children with WPW would need to under further evaluation and testing before their doctor can clear them to participate in high-intensity sports.

It is important to know that once you or anyone you know experience rapid or irregular heartbeat with difficulty breathing and chest pain lasting for more than a few minutes, then urgent medical attention is needed hence it is recommended to right away call 911 or your local emergency number.

3 Causes

Wolff-Parkinson-White Syndrome is genetic, so there is no known cause.

Wolff-Parkinson-White (WPW) syndrome is a congenital condition in which an additional electrical pathway is present between your heart’s upper and lower chambers.

Some studies attribute the development of Wolff-Parkinson-White (WPW) syndrome to a gene mutation or an abnormal gene. While some studies, associate WPW syndrome to Ebstein's anomaly which is another form of congenital heart disease.

Generally, there is little known fact as to the cause of the growth of the extra pathway. The normal anatomy of the heart’s electrical system is as follows:

Your heart is composed of four chambers, two upper chambers called atria and two lower chambers called ventricles.

Sinus node which is a small mass of tissue usually regulate the rhythm of your heart, as it is located in the right atrium. The sinus node creates electrical impulses that led to each heartbeat.

These electrical impulses travel across the atria, to stimulate muscle contractions that will facilitate pumping of blood into the ventricles.

The electrical impulses then arrive at a cluster of cells called the atrioventricular node (AV node), typically the heart only has this pathway that function as a signals to travel from the atria to the ventricles.

The AV node slows the electrical signal before sending it to the ventricles which allows the filling of blood into the ventricles with oxygen reached blood before it is pumped to the lungs and the rest of the body.

In the occurrence of Wolff-Parkinson-White syndrome, instead of just having the electrical impulse just pass the AV nodes the presence of an extra pathway causes pre-excitation or the ventricles are activated too early.

The presence of an additional electrical pathway can lead to two major types of rhythm disturbances, first is the looped electrical impulses.

In WPW, the heart's electrical impulses travel down either the normal (through the AV node) or the extra pathway and up the other one, creating a complete electrical loop of signals known as AV reentrant tachycardia, which sends impulses to the ventricles at a very swift rate.

This condition results to the immediate stimulation of the ventricles pump blood, resulting to an increased heartrate. Second rhythm disturbance is disorganized electrical impulses. If electrical impulses don't start correctly in the right atrium, they may travel across the atria in a messy way, causing the atria to beat very fast and out of step with each other (atrial fibrillation).

The disorganized signals and the extra pathway of WPW also can cause the ventricles to beat faster resulting again to the quickened excitation of the ventricles and not having enough time to fill blood and leads to a decrease in the amount of blood pump into the body.

4 Making a Diagnosis

Individuals suspected with Wolff-Parkinson-White (WPW) syndrome would most likely be referred to cardiologist or a heart doctor to receive a diagnosis. To be able to maximize the time spent with the doctor and not waste any time, here are some things to know about on how you can best prepare for your appointment.

Prepare a list of all the symptoms that you are presenting and including all those that you feel may not be related to the condition, also write down the medications that you have taken or will be taking including supplements and vitamins. Include a list of previous and current medical conditions as well as possible sources of stress in your life.

It is beneficial to understand what WPW syndrome is hence ask your doctor questions that you might find confusing or is concerned about, such questions may be as follows:

  • What is the cause of WPW syndrome?
  • What kinds of tests do I need?
  • What medical managements can help?
  • What are the possible risk for the heart condition?
  • When should I come back for follow-up?
  • Are there any activity restrictions?
  • Will my other conditions be affected by the medications and what are effects to my heart?

As part of the doctor’s assessment, you would also be asked questions:

  • When were the first symptoms experience and how intense was it?
  • What is the frequency of the rapid heartbeat experienced?
  • What are the duration of those episodes?
  • Is there anything that triggers the episodes such as exercise, stress or caffeine?
  • Is there anyone in your family who has heart disease?

Several diagnostic tests will be performed after acquiring your health history and performing physical examination. Here are the tests that will be conducted:

(a) Blood tests, to see thyroid hormone and potassium levels in your blood, which can cause heart rhythm disorders.

(b) Chest X-ray, to see if there is an enlargement of your heart. Next, your doctor will likely recommend heart tests such as:

(c) Electrocardiogram or electrocardiogram (ECG), this test uses small sensors (electrodes) attached to your chest and arms to record electrical signals as they travel through your heart.

Your doctor will look for patterns among these electrical signals that specify the presence of an extra electrical pathway in your heart. This pathway can commonly be seen even when you're not having an episode of a rapid heartbeat.

A home portable ECG devices may also be used to acquire more information about your heart rate. These devices include:

Holter monitor. This portable ECG device can easily fit your pocket or worn on a belt or shoulder strap. Your heart's activity for 24 hours will be monitored which will allow the doctor to see your heart rhythm for the past 24 hour, you will also be tasked to right down any symptoms experienced for the past 24 hours and describe the experience.

Another portable device is the Event recorder. This portable ECG device is used to look into your heart activity for a longer period of time such as about weeks to months. The difference is that it will not continuously be turned on as it would only be activated during episodes of rapid heart rate.

(d) Electrophysiological testing is a test that may be employed to get a definitive diagnosis of Wolff-Parkinson-White syndrome or to pinpoint the location of the extra pathway. Normally, this is an awake procedure in which you will be asked to relax. Thin, flexible tubes (catheters) tipped with electrodes are threaded through your blood vessels to various spots in your heart.

Once in place, the electrodes can exactly show the spread of electrical impulses on every heartbeat and recognize an additional electrical pathway.

5 Treatment

Treatment for Wolff-Parkinson-White (WPW) syndrome would depend on the symptoms presented. Not all individuals with WPW pathway require medical intervention especially if they are asymptomatic.

The main purpose of treatment is to normalize the rapid heart rate and prevent further episodes from occurring. Available treatment options include: Vagal maneuvers, these involves simple physical movements, which include coughing, bearing down as if you are having a bowel movement, and putting an ice pack on your face, such movements affect a nerve that helps regulate your heartbeat (vagus nerve).

Your doctor may teach you several vagal maneuvers that would help manage the rapid heartbeat as it happens. Medications such as an injection of an anti-arrhythmic drug may be given if the rapid heart rate is not improved by the vagal maneuvers. A maintenance drug to slow the heart rate may also be recommended.

Cardioversion. Your doctor may use paddles or patches on your chest to electrically shock your heart and help restore a normal rhythm. Cardioversion is generally only used when maneuvers and medications aren't working.

Radiofrequency catheter ablation. Thin, flexible tubes (catheters) are eased through blood vessels to your heart, the electrodes at the catheter tips are heated and are able to destroy (ablate) the extra electrical pathway that is causing your condition. Radiofrequency ablation is effective in up to 95 percent of people with Wolff-Parkinson-White syndrome.

Regular outpatient follow-ups may be recommended by your doctor to continue monitoring your heart rhythm and rate.

6 Prevention

There is no way to prevent Wolff-Parkinson-White (WPW) syndrome but you can prevent the symptoms with proper treatment such as:

  • putting ice packs on your face to regulate your heartbeat,
  • patches that will be placed on your chest to restore a normal rhythm.

7 Alternative and Homeopathic Remedies

There are no known homeopathic remedies for Wolff-Parkinson-White (WPW) syndrome.

8 Lifestyle and Coping

Some of the helpful lifestyle suggestions for Wolff-Parkinson-White (WPW) syndrome include:

  • avoiding smoke,
  • eat a heart-healthy diet,
  • maintain a healthy weight,
  • get regular exercise.

Consult your doctor if you have other conditions such as high cholesterol and if you have symptoms.

9 Risks and Complications

There are several complications associated with Wolff-Parkinson-White (WPW) syndrome.

Generally, Wolff-Parkinson-White syndrome doesn't bring about serious medical problems. But complications can develop, especially if you have a serious heart-related problem that was not detected and treated.

If the condition remains untreated, and particularly if you have an underlying heart condition then you may experience:

  • Fainting spells (syncope),
  • fast heart beats (tachycardia),
  • seldom, sudden death.

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