Wolff-Parkinson-White syndrome occurs when there is a problem with the electrical pathway between one of the upper chambers of the heart, or atria, and one of the lower chambers, or ventricles.
A person who has Wolff-Parkinson-White (WPW) syndrome is born with the extra electrical pathway that affects the beat of their heart.
The heart's electrical signal bounces around as it moves too quickly from the atrium to the ventricle and, sometimes, back again. This activity can cause the heart to beat too fast. The name of this rapid heart rate is tachycardia.
People with WPW syndrome can experience symptoms at any age. Periods of tachycardia can cause:
- chest pain
- shortness of breath
In rare instances, WPW syndrome can result in a cardiac arrest. At the other end of the scale, some people with WPW never have symptoms.
The human heart consists of two upper chambers and two lower chambers. The two upper chambers are the left and right atria. The two lower chambers are the left and right ventricles.
The heart's electrical system tells the heart when to contract. If there is an extra electrical connection inside the heart, it acts as a short circuit, making the heart beat abnormally. It may be too fast or irregular.
WPW syndrome affects between 1 and 3 in every 1,000 people.
If a person has WPW syndrome, there is a problem with the communication from the atria to the ventricles. The signal goes around this normal electrical center of the heart and causes the ventricles to beat sooner than they should.
It is unclear exactly why this extra electrical pathway develops, but a small percentage of people with WPW syndrome have a genetic mutation. Others are born with a heart defect.
The WPW pathway is usually present at birth, but not all infants have symptoms. An infant with the condition may show signs of:
- rapid breathing
- poor appetite
- rapid heartbeat
Often, the signs and symptoms of WPW syndrome will not start until children are older, possibly in their teens or 20s. Some never have symptoms.
When symptoms are present, they can include:
- dizziness and fainting
- poor endurance and tiring easily during exercise
Periods of tachycardia can begin suddenly and last for less than a minute, or they can persist for several hours.
In more severe cases, a person may experience:
- tightness in the chest
- breathing problems
- chest pain
In severe cases, sudden death is possible.
Some people feel nothing, and they are unaware that there is a problem. They may find out that they have WPW when they see a doctor about a different matter.
Treatment will depend on the type of abnormal rapid rhythm that is present. Some fast rhythms are not life-threatening, but others are.
When a person's heart rate speeds up, treatment aims to slow it down to a normal rate and to stop it from happening again, if possible.
Home remedies: Vagal maneuvers
Sometimes, a person's rapid heartbeat corrects itself. Alternatively, some simple physical movements may help to correct the heartbeat.
These exercises include:
- bearing down as if having a bowel movement
- massaging the sides of the neck over the carotid artery
- holding an ice pack on the face
- gagging or forceful coughing
Therapists call these exercises vagal maneuvers because they affect the vagus nerve that runs from the abdomen to the brain. A branch of it runs to the heart.
Stimulation of the vagus nerve can cause a variety of results, depending on what organ it affects. If the heart is beating too fast, it acts as a brake and slows the heart rate down.
If vagal maneuvers do not normalize the heart rhythm, a doctor may inject an antiarrhythmic drug to bring the heartbeat back to normal.
Another option is a procedure known as cardioversion. This intervention is when a doctor places paddles or patches on the person's chest and applies an electric shock to the heart, to restore normal heart rhythm.
Doctors usually use cardioversion for people who have not responded to vagal maneuvers or medication.
Sometimes, a person may need more invasive procedures to prevent future episodes.
In radiofrequency ablation (RFA), a heart specialist can thread a catheter through the blood vessels and up into the heart. At the tips of the catheters are electrodes. By heating these, the surgeon can damage or destroy the extra pathway so that the heart will no longer beat too fast.
Some medications can help to prevent further episodes, especially in people who do not want to undergo RFA or who cannot have it for some reason.
Nowadays, RFA has replaced surgery as the first-line treatment for WPW, as it is simpler and has fewer risks. However, if a patient needs heart surgery for another issue, the doctor may destroy the extra electrical pathway surgically at the same time.
Those who have WPW syndrome but do not have any symptoms may not require treatment.