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Wolff-Parkinson-White syndrome (WPW)

Show Alternative Names
Preexcitation syndrome
WPW
Tachycardia - Wolff-Parkinson-White syndrome
Arrhythmia - WPW
Abnormal heart rhythm - WPW
Rapid heartbeat - WPW

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

WPW syndrome is one of the most common causes of fast heart rate problems in infants and children.

Cardiac conduction system disorders - overview - Animation

The atria, and their respective ventricles, are electrically insulated from each other by a fibrous tissue known as the atrioventricular (AV) junction. Impulses are transferred via a special bridge, called the His-Purkinje system (HPS). Some individuals, however, have additional bridges called accessory pathways. Irregular heartbeats resulting from impulses passing through accessory pathways are called supraventricular. Supraventricular tachycardias (SVT) may be atrial or AV junctional. In atrial tachycardia, the impulse arises from the superior portion of either atrium. This condition may arise when the tissues of the atria or pericardium, the membrane covering the heart, are affected by a chronic or acute inflammation, dilation or enlargement of an atrium, or formation of reparative tissue called fibrosis. Re-entry tachycardias result from congenital accessory pathways, and can be manifested at any age. AV nodal re-entry (AVNR) is the most common AV junctional tachycardia. The re-entry circuit is localized in the AV node, a small node involved in the conduction system of the heart. AV nodal re-entry results from differences in conducting fibers leading to divergence in impulses. Wolff-Parkinson-White syndrome is one of the most frequently encountered accessory pathway syndromes. The incidence is approximately 150 cases per year per 100,000 individuals. Electrical impulses bypass the AV node and travel along the bundle of Kent accessory pathway instead. This results in ventricular pre-excitation, because the impulse reaches the ventricle prematurely. Very rapid heartbeats, a complication of Wolff-Parkinson-White, can result in severe hypotension and syncope, or loss of consciousness.

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 WPW syndrome, some of the heart's electrical signals go down an extra pathway. This may cause a very rapid heart rate called supraventricular tachycardia.

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.

Symptoms

How often a rapid heart rate occurs varies depending on the person. Some people with WPW 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

A physical exam done during a tachycardia episode will show a heart rate faster than 100 beats per minute. A normal 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 person is not having tachycardia at the time of the exam, the results may be normal. The condition may be diagnosed with an electrocardiogram (ECG) or with ambulatory ECG monitoring, such as a Holter 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, health care providers may use a type of therapy called electrical cardioversion (shock).

The long-term treatment for WPW 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). This is done as part of an electrophysiologic study (EPS).

Before ablation is considered, you may be asked to undergo an exercise stress test to help decide if you need ablation.

Open heart surgery to burn or freeze the extra pathway may also provide a permanent cure for WPW 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 people. The success rate for the procedure ranges between 85% to 95%. Success rates will vary depending on the location and number of extra pathways.

Possible Complications

Complications may include:

The most severe form of a rapid heartbeat is ventricular fibrillation (VF), which will rapidly lead to shock or death unless it is corrected. It can sometimes occur in people with WPW, particularly if they also have atrial fibrillation (AF), which is another type of abnormal heart rhythm. This type of rapid heartbeat requires emergency treatment and a procedure called cardioversion.

When to Contact a Medical Professional

Contact your provider if:

  • You have symptoms of WPW syndrome.
  • You have this disorder and symptoms get worse or do not improve with treatment.

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

Review Date: 2/27/2024

Reviewed By

Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

References

Dalal AS, Van Hare GF. Disturbances of rate and rhythm of the heart. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 462.

Kalman JM, Sanders P. Supraventricular Tachycardias. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 65.

Zimetbaum P, Goldman L. Supraventricular ectopy and tachyarrhythmias. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 52.

Disclaimer

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Cardiac conduction system disorders - overview - Animation

The atria, and their respective ventricles, are electrically insulated from each other by a fibrous tissue known as the atrioventricular (AV) junction. Impulses are transferred via a special bridge, called the His-Purkinje system (HPS). Some individuals, however, have additional bridges called accessory pathways. Irregular heartbeats resulting from impulses passing through accessory pathways are called supraventricular. Supraventricular tachycardias (SVT) may be atrial or AV junctional. In atrial tachycardia, the impulse arises from the superior portion of either atrium. This condition may arise when the tissues of the atria or pericardium, the membrane covering the heart, are affected by a chronic or acute inflammation, dilation or enlargement of an atrium, or formation of reparative tissue called fibrosis. Re-entry tachycardias result from congenital accessory pathways, and can be manifested at any age. AV nodal re-entry (AVNR) is the most common AV junctional tachycardia. The re-entry circuit is localized in the AV node, a small node involved in the conduction system of the heart. AV nodal re-entry results from differences in conducting fibers leading to divergence in impulses. Wolff-Parkinson-White syndrome is one of the most frequently encountered accessory pathway syndromes. The incidence is approximately 150 cases per year per 100,000 individuals. Electrical impulses bypass the AV node and travel along the bundle of Kent accessory pathway instead. This results in ventricular pre-excitation, because the impulse reaches the ventricle prematurely. Very rapid heartbeats, a complication of Wolff-Parkinson-White, can result in severe hypotension and syncope, or loss of consciousness.
 

Cardiac conduction system disorders - overview - Animation

The atria, and their respective ventricles, are electrically insulated from each other by a fibrous tissue known as the atrioventricular (AV) junction. Impulses are transferred via a special bridge, called the His-Purkinje system (HPS). Some individuals, however, have additional bridges called accessory pathways. Irregular heartbeats resulting from impulses passing through accessory pathways are called supraventricular. Supraventricular tachycardias (SVT) may be atrial or AV junctional. In atrial tachycardia, the impulse arises from the superior portion of either atrium. This condition may arise when the tissues of the atria or pericardium, the membrane covering the heart, are affected by a chronic or acute inflammation, dilation or enlargement of an atrium, or formation of reparative tissue called fibrosis. Re-entry tachycardias result from congenital accessory pathways, and can be manifested at any age. AV nodal re-entry (AVNR) is the most common AV junctional tachycardia. The re-entry circuit is localized in the AV node, a small node involved in the conduction system of the heart. AV nodal re-entry results from differences in conducting fibers leading to divergence in impulses. Wolff-Parkinson-White syndrome is one of the most frequently encountered accessory pathway syndromes. The incidence is approximately 150 cases per year per 100,000 individuals. Electrical impulses bypass the AV node and travel along the bundle of Kent accessory pathway instead. This results in ventricular pre-excitation, because the impulse reaches the ventricle prematurely. Very rapid heartbeats, a complication of Wolff-Parkinson-White, can result in severe hypotension and syncope, or loss of consciousness.
 
 
 
 

 

 
 
 
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