Wolff-Parkinson-White Disease

Wolff-Parkinson-White (WPW) disease is a condition in which there is an extra electrical pathway in the heart that leads to periods of rapid heart rate (tachycardia).

Your heart is made up of four chambers—two upper chambers (atria) and two lower chambers (ventricles). The right atrium normally controls the rhythm of your heart. It produces electrical impulses that cause each heartbeat. These electrical signals travel across the atria and arrive at a cluster of cells called the atrioventricular (AV) node. The AV node slows the electrical signal. This slight delay allows the ventricles to fill with blood.

In WPW disease, an extra electrical pathway connects the atria and ventricles, allowing electrical impulses to bypass the AV node. This detour activates the ventricles too early. The extra pathway can also transmit electrical impulses from the ventricles back to the atria, leading to heart rhythm changes.

For many people, WPW disease doesn't cause serious problems. But complications can occur. It's not always possible to know your risk.

What happens once you have Wolff-Parkinson-White disease?

WPW, which is present at birth, is fairly rare. Most people who do have it don't have serious problems, but complications can occur. It's not always possible to know your risk of serious heart-related events.

If WPW syndrome is untreated—particularly if you have other heart conditions—you might have symptoms like:

• Fainting.


• Fatigue.


• Anxiety.


• Chest pain.


• Shortness of breath.


• Difficulty breathing.


• Dizziness or lightheadedness.


• Rarely, sudden cardiac arrest.


• A rapid, fluttering, or pounding heartbeat (palpitations).

Signs and symptoms in infants with WPW syndrome can include:

• Poor eating.


• Rapid breathing.


• Restlessness or irritability.


• Grayish or blueish (ashen) skin color.

What causes Wolff-Parkinson-White disease?

Most people with WPW 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. The extra electrical pathway that causes a rapid heartbeat is present at birth.

Episodes can occur during exercise or while at rest. Caffeine or other stimulants and alcohol trigger symptoms for some people. Otherwise, little is known about why the extra pathway develops.

What types of tests are used to diagnose Wolff-Parkinson-White disease?

Your doctor will likely recommend tests to diagnose WPW syndrome, such as:

• Electrocardiogram (EKG): Small sensors attached to your chest and arms record electrical signals as they travel through your heart.


• Holter monitor: A Holter monitor is a portable EKG device that you wear at home. The device records your heart's activity while you perform your everyday activities for a day or two.


• Electrophysiological testing: Thin, flexible tubes (catheters) tipped with electrodes are threaded through your blood vessels to various spots in your heart. The electrodes map the spread of electrical impulses during each heartbeat and identify an extra electrical pathway.

What types of treatments and procedures are used to treat Wolff-Parkinson-White disease?

Treatment for WPW depends on several factors, including the severity and frequency of your symptoms and the type of arrhythmia you have. If you have the WPW pathway but don't have symptoms, you probably won't need treatment. If you do, the treatment goal is to slow a fast heart rate when it occurs and prevent future episodes.

Treatment options include:

• Vagal maneuvers: These simple physical movements include coughing, bearing down as if you have a bowel movement, and putting an ice pack on your face—affect a nerve that helps regulate your heartbeat (vagus nerve).


• Medications: You might need an injection of an anti-arrhythmic medication to slow the heart rate.


• Cardioversion: Paddles or patches on your chest can electrically shock your heart and help restore a normal rhythm.


• Radiofrequency catheter ablation: Thin, flexible tubes (catheters) are threaded through blood vessels to your heart. Electrodes at the catheter tips are heated to destroy (ablate) the extra electrical pathway causing your condition. Radiofrequency ablation permanently corrects the heart-rhythm problems in most people with WPW disease.

What can I do to support my health when I have Wolff-Parkinson-White disease?

WPW symptoms can disappear over time.

For those who continue to experience symptoms, living with WPW can be frustrating. Unless you know your trigger, you can’t anticipate when your heartbeat will become rapid. And you don’t know how long it will stay that way.

Why choose Presbyterian for Wolff-Parkinson-White disease?

Presbyterian’s Heart and Vascular team has many different options to help you manage your heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart condition you have and its underlying cause, the team can recommend a wide variety of treatment options, including lifestyle modifications, medications, and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, where clinically appropriate, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.