Most people have awareness of heart beats (palpitations), and some feel weak or short of breath.
Electrocardiography is used to make the diagnosis.
Usually, episodes can be stopped by maneuvers that stimulate the vagus nerve, which slows the heart rate.
(See also Overview of Abnormal Heart Rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more and see Paroxysmal Supraventricular Tachycardia Paroxysmal Supraventricular Tachycardia (SVT, PSVT) Paroxysmal supraventricular tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles... read more .)
Wolff-Parkinson-White syndrome is the most common of several disorders that involve an extra (accessory) electrical pathway between the atria and the ventricles. (Such disorders may produce atrioventricular reciprocating supraventricular tachycardias Paroxysmal Supraventricular Tachycardia (SVT, PSVT) Paroxysmal supraventricular tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles... read more .) This extra pathway makes fast abnormal heart rhythms (arrhythmias) more likely to occur.
The abnormal pathway that causes Wolff-Parkinson-White syndrome is present at birth, but the arrhythmias it causes usually become apparent only during the teens or early twenties. However, arrhythmias may occur during the first year of life or not until after age 60.

Symptoms of WPW Syndrome
Wolff-Parkinson-White syndrome is a common cause of paroxysmal supraventricular tachycardia Paroxysmal Supraventricular Tachycardia (SVT, PSVT) Paroxysmal supraventricular tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles... read more . Very rarely, this syndrome results in a very fast, life-threatening heart rate during atrial fibrillation Atrial Fibrillation and Atrial Flutter Atrial fibrillation and atrial flutter are very fast electrical discharge patterns that make the atria (upper chambers of the heart) contract very rapidly, with some of the electrical impulses... read more .
When infants develop arrhythmias due to this syndrome, they may become short of breath or lethargic, stop eating well, or have rapid, visible pulsations of the chest. Heart failure may develop.
Typically, when teenagers or people in their early 20s have an arrhythmia due to this syndrome, they experience it as an episode of palpitations Palpitations Palpitations are the awareness of heartbeats. The sensation may feel like pounding, fluttering, racing, or skipping beats. Other symptoms—for example, chest discomfort or shortness of breath—may... read more that begins suddenly, often during exercise. The episode may last for only a few seconds or may persist for several hours. For most people, the very fast heart rate is uncomfortable and distressing. A few people faint Fainting Light-headedness (near syncope) is a sense that one is about to faint. Fainting (syncope) is a sudden, brief loss of consciousness during which the person falls to the ground or slumps in a... read more .
In older people, episodes of paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome tend to cause more symptoms, such as fainting, shortness of breath, and chest pain.
Atrial fibrillation and Wolff-Parkinson-White syndrome
Atrial fibrillation Atrial Fibrillation and Atrial Flutter Atrial fibrillation and atrial flutter are very fast electrical discharge patterns that make the atria (upper chambers of the heart) contract very rapidly, with some of the electrical impulses... read more may be particularly dangerous for people with Wolff-Parkinson-White syndrome. The extra pathway can conduct the rapid impulses to the ventricles at a much faster rate than the normal pathway (through the atrioventricular node) can. The result is an extremely fast ventricular rate that may be life threatening. Not only is the heart very inefficient when it beats so rapidly, but this extremely fast heart rate may also progress to ventricular fibrillation Ventricular Fibrillation Ventricular fibrillation is a potentially fatal, uncoordinated series of very rapid, ineffective contractions of the ventricles (lower chambers of the heart) caused by many chaotic electrical... read more , which is fatal unless treated immediately.
Diagnosis of WPW Syndrome
Electrocardiography
Because Wolff-Parkinson-White syndrome changes the pattern of electrical activation in the heart, it can be diagnosed using electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. This record, the electrocardiogram (also known as an ECG)... read more (ECG), which records the electrical activity of the heart.
Treatment of WPW Syndrome
Maneuvers and drugs to convert heart rhythm
Sometimes ablation
Episodes of paroxysmal supraventricular tachycardia Paroxysmal Supraventricular Tachycardia (SVT, PSVT) Paroxysmal supraventricular tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles... read more due to Wolff-Parkinson-White syndrome can often be stopped by one of several maneuvers that stimulate the vagus nerve and thus slow the heart rate. Maneuvers include
Straining as if having a difficult bowel movement
Rubbing the neck just below the angle of the jaw (which stimulates a sensitive area on the carotid artery called the carotid sinus)
Plunging the face into a bowl of ice-cold water
These maneuvers are most effective when they are used shortly after the arrhythmia starts.
When these maneuvers are ineffective, drugs such as verapamil, diltiazem, or adenosine are usually given intravenously to stop the arrhythmia. Antiarrhythmic drugs may then be continued indefinitely to prevent episodes of a fast heart rate (see table ).
In infants and children younger than 10 years, digoxin may be given to suppress episodes of paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome. However, adults with the syndrome should not take digoxin because it can facilitate conduction by the extra pathway and increase the risk that atrial fibrillation will degenerate into ventricular fibrillation. For this reason, digoxin is usually stopped before people with this syndrome reach puberty.
Ablation
Destruction of the extra conduction pathway by catheter ablation Destroying Abnormal Heart Tissue (Ablation) There are many causes of abnormal heart rhythms (arrhythmias). Some arrhythmias are harmless and do not need treatment. Sometimes arrhythmias stop on their own or with changes in lifestyle,... read more (delivery of energy using radiowaves, laser pulses, or high-voltage electrical current or freezing with cold through a catheter inserted in the heart) is successful in more than 95% of people. The risk of death during the procedure is less than 1 in 1,000. Ablation is particularly useful for young people who might otherwise have to take antiarrhythmic drugs for a lifetime.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
American Heart Association: Arrhythmia: Information to help people understand their risks of arrhythmias as well as information on diagnosis and treatment
Drugs Mentioned In This Article
Generic Name | Select Brand Names |
---|---|
verapamil |
Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM |
diltiazem |
Cardizem, Cardizem CD, Cardizem LA, Cardizem SR, Cartia XT , Dilacor XR, Dilt-CD , Diltia XT, Diltzac, Matzim LA, Taztia XT, TIADYLT ER, Tiamate, Tiazac |
adenosine |
Adenocard, Adenoscan |
digoxin |
Digitek , Lanoxicaps, Lanoxin, Lanoxin Pediatric |