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Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome is a condition in which there is an extra electrical pathway of the heart. The condition can lead to periods of rapid heart rate (tachycardia ).

Wolff-Parkinson-White syndrome is one of the most common causes of fast heart rate problems in infants and children.

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Alternative Names

Preexcitation syndrome; WPW

Causes

Normally, electrical signals follow a certain pathway through the heart. This helps the heart beat regularly. This prevents the heart from having extra beats or beats happening too soon.

In people with Wolff-Parkinson-White syndrome, some of the heart's electrical signal goes down an extra pathway. This may cause a very rapid heart rate called supraventricular tachycardia.

Most people with Wolff-Parkinson-White syndrome do not have any other heart problems. However, this condition has been linked with other cardiac conditions, such as Ebstein anomaly . A form of the condition also runs in families.

Ebstein's anomaly

Symptoms

How often a rapid heart rate occurs varies depending on the person. Some people with Wolff-Parkinson-White syndrome have only a few episodes of rapid heart rate. Others may have the rapid heart rate once or twice a week or more. Also, there may be no symptoms at all, so that condition is found when a heart test is done for another reason.

A person with this syndrome may have:

Exams and Tests

An exam done during a tachycardia episode will show a heart rate faster than 100 beats per minute. An abnormal heart rate is 60 to 100 beats per minute in adults, and under 150 beats per minute in newborns, infants, and small children. Blood pressure will be normal or low in most cases.

If the patient is not having tachycardia at the time of the exam, the results may be normal. Wolff-Parkinson-White syndrome may be diagnosed through a continuous ambulatory ECG monitoring, such as with a Holter monitor .

Holter heart monitor

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

Treatment

Medicines, particularly antiarrhythmic drugs such as procainamide or amiodarone, may be used to control or prevent a rapid heartbeat.

If the heart rate does not return to normal with medical treatment, doctors may use a type of therapy called electrical cardioversion (shock).

The long-term treatment for Wolff-Parkinson-White syndrome is very often catheter ablation. This procedure involves inserting a tube (catheter) into a vein through a small cut near the groin up to the heart area. When the tip reaches the heart, the small area that is causing the fast heart rate is destroyed using a special type of energy called radiofrequency or by freezing it (cryoablation).

Open heart surgery to burn or freeze the extra pathway may also provide a permanent cure for Wolff-Parkinson-White syndrome. In most cases, this procedure is done only if you need heart surgery for other reasons.

Outlook (Prognosis)

Catheter ablation cures this disorder in most patients. The success rate for the procedure ranges between 85 and 95%. Success rates will vary depending on the location and number of extra pathways.

Possible Complications


The most severe form of a rapid heartbeat is ventricular fibrillation (VF), which may rapidly lead to shock or death. This type of rapid heartbeat requires emergency treatment and a procedure called cardioversion.

When to Contact a Medical Professional

Call your health care provider if:

  • You have symptoms of Wolff-Parkinson-White syndrome
  • You have this disorder and symptoms get worse or do not improve with treatment

Talk to your health care provider about whether your family members should be screened for inherited forms of this condition.

References

Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, MO: WB Saunders; 2011:chap 39.

Zimetbaum P. Cardiac arrhythmias with supraventricular origin. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 64.

Updated: 5/13/2014

Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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