Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome explained

What is Wolff-Parkinson-White syndrome?

Wolff-Parkinson-White syndrome is a type of abnormal heart rhythm that affects adults and children. It happens when there is an extra electrical connection in the heart. 

This added pathway can allow extra electrical signals to be sent from the upper and lower heart chambers of your heart. The added electrical signals can cause you to have a very fast irregular heartbeat, known as tachycardia.

People with WPW syndrome are born with it (congenital), although symptoms may not come up until later in life. Many healthy young adults and children can be diagnosed with it.

Some people with this extra electrical connection do not have an irregular heartbeat (tachycardia). This means they have a Wolff-Parkinson-White (WPW) pattern and not WPW syndrome. Sometimes WPW syndrome settles down on its own.

How common is WPW syndrome?

WPW syndrome affects between 1 and 3 people out of 1,000. It is sometimes found to run in families and is more common in men than women.

Signs and symptoms

What are the symptoms of WPW syndrome in adults?

Symptoms will affect people differently. They can affect people for minutes, seconds or hours. In a few cases they can last for days. How often they happen can vary, with some people being affected daily, while others only experience them a few times a year, or never.

They can sometimes be triggered by strenuous exercise, stress, caffeine or drinking alcohol.  

If people do get symptoms, they can include:

• a pounding or fluttering feeling in your chest (palpitations)
• feeling lightheaded or dizzy
• fainting
• shortness of breath
• feeling anxious
• sweating
• chest pain or discomfort.

Some people do not experience any symptoms. They have WPW pattern but have not experienced a fast heartbeat (tachycardia).

Symptoms will affect people differently. They can affect people for minutes, seconds or hours. In a few cases they can last for days. How often they happen can vary, with some people being affected daily, while others only experience them a few times a year, or never.

They can sometimes be triggered by strenuous exercise, stress, caffeine or drinking alcohol.  

What are the symptoms of WPW in babies and children?

WPW may show up a little differently in babies and small children.

Symptoms can include:

• not eating well
• acting restless or unsettled
• a blue or grey tint to the skin, lips or nails
• fast breathing or difficulty breathing.

Fainting is rare and usually only happens if their heart has been racing for over 30 minutes. Book an appointment with your GP if you see these symptoms in your child.

When should I get medical help for my symptoms?

See your GP if you keep getting a fast or noticeable heartbeat (palpitations). It's important to get it checked out in case it could be something serious.

Call 999 immediately if:

• Your heartbeat does not go back to normal in a few minutes.
• You have pain in your chest, neck, jaw, arms or back for more than 15 minutes.
• You have a fast heartbeat and feel breathless, sweaty, sick or you’ve been sick.
• You faint and someone cannot wake you up.

If you've already been diagnosed with WPW syndrome and you experience an episode, first try the techniques you've been taught or take any medicines you've been given.

Causes

What causes WPW syndrome?

When the heart beats, its walls tighten and squeeze (contract) to force blood out and around the body. The walls then relax, allowing the heart to fill with blood again. This is controlled by electrical signals.

In WPW syndrome there is an extra signalling pathway between the heart's upper and lower chambers. This pathway creates a loop that should not be there. Electrical signals travel round the loop, causing your heart to beat very fast (tachycardia). 

Can WPW syndrome cause other conditions?

It can be worrying to be told you have a problem with your heart, but WPW syndrome is not usually serious. Many people will rarely experience episodes of a fast heartbeat and may have no symptoms at all (WPW pattern).

Sometimes, people with WPW syndrome can also have another heart condition called atrial fibrillation (AF). This can increase their risk of having a very fast heartbeat that can become life-threatening if it’s not treated. But this is rare. 

People in high-risk jobs (like a pilot or a professional athlete) and people at risk of a life-threatening heart rhythm may be offered treatment to lower their risk.

Is WPW syndrome hereditary?

Diagnosis

How is WPW syndrome diagnosed?

There are two ways WPW syndrome is usually diagnosed:

1. During or after an episode of a fast heartbeat (tachycardia) needing medical attention where a WPW pattern is seen on an ECG.
2. During routine investigations for palpitations where WPW pattern is seen on an ECG.

If you’re experiencing symptoms and your doctor thinks you might have WPW syndrome, you may have any of these tests:

• an ECG or 24 hour ECG
• an echocardiogram
• a treadmill or exercise test
• electrophysiological (EP) studies
• adenosine test -  a small amount is injected through a vein. It allows the doctors to see any ‘extra’ pathways linked to WPW.

Treatment

Will I need treatment for WPW syndrome?

WPW is treated based on your symptoms.

You have WPW pattern but do not have a fast heartbeat 

You have WPW pattern, but you’ve never had a fast heartbeat. This means you probably will not need treatment, and for some young people it gets better as they grow up. People with high-risk jobs, like pilots or professional athletes, sometimes have extra tests to check their heart. 

You have WPW pattern and symptoms caused by a fast heartbeat 

If you have WPW pattern and symptoms, you will have treatment to stop the fast heartbeat (tachycardia) and return the heart rate and rhythm back to normal.

You may have 1 or more of these treatments: 

• Vagal manoeuvres to slow down your heartbeat. 
• Medicine to block the extra electrical signals in your heart. 
• Cardioversion to reset your heart’s rhythm. 

You’ve been diagnosed with WPW syndrome and have symptoms caused by a fast heartbeat  

If you have WPW syndrome and symptoms, you will have treatment help prevent episodes including:

• Medicine to block the extra electrical signals in your heart. 
• Catheter ablation to destroy the tissue causing extra electrical impulses.  
• Lifestyle changes to avoid things that can trigger an episode, like alcohol, caffeine and intense exercise.  

Your doctor can answer any questions you might have.

For many people with WPW syndrome, their episodes of a fast heartbeat are short, harmless and settle down on their own. You might not need any treatment if your symptoms are mild or rare.

Even if you do not need treatment, it’s important to go to all your appointments with your doctor or specialist. They will regularly check how your heart is working to keep you healthy. If your specialist thinks you need treatment, they’ll discuss the options with you.

What are vagal manoeuvres?  

Vagal manoeuvres are techniques that help slow your heartbeat. They work by stimulating nerves that calm your heart’s electrical messages. Your doctor will show you how to do them and explain which ones are right for you.  

• Coughing - this can create pressure in your chest which can trigger your vagus nerve. 
• The Valsalva manoeuvre - breathe out through your mouth hard whist pinching your nose tightly. The pressure can set your heart off into its normal rhythm.
• Holding your knees against your chest.
• Ice or cold water - cold showers, cold baths, ice packs on the face or putting your face in very cold water for a few seconds can help to lower your heart rate.
• Gag reflex - causing yourself to lightly gag can get the vagus nerve working.

Get support

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• Sign up to our Heart Matters magazine for online information packed with health and lifestyle advice.
• Find out more about how your heart and circulatory system works.
• Join our online community, HealthUnlocked to speak to people affected by the same condition.