Wolff-Parkinson-White syndrome

Wolff-Parkinson-White happens when there is an extra electrical connection in the heart. This problem with the heart is present at birth (congenital), although symptoms may not develop until later in life. Many healthy young adults get diagnosed with it.

Some people with this extra electrical connection don't have an irregular heart beat (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?

It affects between 1 and 3 people out of a thousand. It is sometimes found to run in families and is more common in men than women

What causes WPW syndrome?

When the heart beats, its walls contract (tighten and squeeze) 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 ‘short circuit’ that shouldn’t be there. Electrical signals travel round the ‘short circuit’ in a loop, causing episodes of tachycardia (where the heart beats very fast).

What are the symptoms of WPW syndrome?

Some people don’t experience any symptoms. They have WPW pattern but haven’t experienced a fast heart rate (tachycardia).

If people do get symptoms, they can include:

• palpitations (a pounding or fluttering feeling in your chest or neck)
• feeling light-headed, dizzy or faint (pre syncope)
• fainting (known as syncope)
• shortness of breath
• feeling anxious
• sweating
• chest pain or discomfort.

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.  

When should I seek medical advice 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.

You, or someone with you, should call 999 immediately if:

• your heartbeat doesn’t go back to normal in a few minutes
• you have pain in your check, neck, jaw, arms or back for more than 15 minutes
• you have a fast heartbeat as well as other symptoms like feeling sick, being sick, feeling breathless or sweating
• you faint and someone can’t 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 medication you've been given.

If symptoms don’t improve or if someone you know has WPW syndrome and collapses or faints call 999 immediately. 

How is WPW syndrome diagnosed?

There are two ways WPW syndrome is usually diagnosed:

1. During or after an episode of a fast heart rate (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
• an ambulatory ECG - a small, portable ECG recorder to continue monitoring your heart for 24 hours or a few days. You’ll have some small sticky pads put on your chest. They’ll be attached to a small recording device which you’ll wear on a belt around your waist
• adenosine -  a small amount is injected through a vein. It allows the doctors to see any ‘extra’ pathways linked to WPW
• an echocardiogram
• a treadmill or exercise test
• electrophysiological (EP) studies.

What are the risks and complications of having WPW syndrome?

It can be worrying to be told you have a problem with your heart, but WPW syndrome usually isn’t 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 rhythm may be offered treatment to lower their risk.

Will I need treatment for WPW syndrome?

WPW is treated based on your symptoms.

You have the WPW pattern but have never had any episodes of tachycardia

You have the extra signalling pathway (WPW pattern) but have never had any episodes of fast heart rate (tachycardia). This means that you probably won't need treatment, and in some young people, the condition disappears or improves as you get older. People in high risk jobs (like a pilot or professional athlete) are usually offered tests to check their risk of having a sudden cardiac arrest.

You’ve got the extra signalling pathway (WPW pattern) and you have symptoms caused by a fast heart rate (tachycardia)

The priority is to stop the tachycardia and return the heart rate and rhythm back to normal. There are a few ways that this can be treated:
 
Vagal manoeuvres – these are different techniques to help get your heart rate back to normal. They stimulate nerves that slow down your heart’s electrical messages. Your doctor will teach you the techniques and let you what ones will be best for you.

Medication – if vagal manoeuvres don’t work, you might be given an injection of some medicine to block the extra electrical signals in your heart. This will make your heart’s electrical messages travel through the normal path and set your heartbeat back to normal.

Cardioversion- this sets your heart rhythm back to a normal pattern by sending controlled electrical signals to your heart. Your specialist will then offer treatment to avoid this from happening again.

You’ve been diagnosed with WPW syndrome and continue to have episodes of fast heart rate (tachycardia)

Your specialist will then look at ways of preventing symptoms. Techniques and treatments that can help prevent episodes include:

Medication – to control the speed of the electrical messages being sent to your heart or to take during an episode.

Lifestyle choices – you may be told to avoid things that could trigger an episode. This can include having less alcohol and caffeine and avoiding intense exercise, like running or competitive sports. Your doctor can answer any questions you might have.

Catheter ablation – this procedure is commonly used to destroy the extra part of the heart causing the problems in the heart's electrical system. It works with most people and is very effective. 

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 don’t 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. 

Types of vagal manoeuvres

• 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.

Genetic services

Although it’s very rare, WPW syndrome can be passed down through families. Inherited conditions are caused by a change in one of your genes. Our genes make up who we are, and we inherit them from our parents.

When you or a member of your family are suspected to have an inherited heart or circulatory condition, it can feel worrying. If you have questions or concerns, the cardiac nurses in our Genetic Information Service can support you and help you understand your condition.

• Find out more about our genetic information service.

Heart Helpline & other support

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• Contact us to talk to our customer care advisors, find your local BHF shop and for any comments, compliments and complaints you may have.
• 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.