Arrhythmias
Wolff Parkinson White syndrome WPW
Wolff Parkinson White syndrome, often shortened to WPW, is a heart rhythm condition in which the electrical impulse uses an extra connection instead of following the heart's normal pathway. That extra connection forms a short circuit, and the short circuit can trigger a rapid heart rhythm, or tachycardia. It is one of the forms of supraventricular tachycardia that Dr Jogiya sees commonly, and it is usually identified on an ECG.
What Wolff Parkinson White syndrome is
Wolff Parkinson White syndrome, also written Wolff-Parkinson-White, is a condition in which the electrical conduction in the atria does not follow the normal pathway. Instead of travelling only along the heart's usual route, the impulse also uses an extra electrical connection. A short circuit then forms, and it is that short circuit which triggers a rapid heart rhythm, or tachycardia.
WPW is a form of supraventricular tachycardia, commonly shortened to SVT. An SVT is a fast heart rhythm that originates above the ventricles. The atria are the upper chambers, and they receive blood into the heart before the lower chambers pump it on to the lungs or to the rest of the body.
The condition might be congenital, meaning it is present from birth, but most symptoms are not present until later on in life. Many people are well into adulthood before the extra pathway makes itself known.
- The electrical impulse uses an extra connection rather than following the heart's normal pathway
- A short circuit forms, which triggers a rapid heart rhythm or tachycardia
- WPW is a form of supraventricular tachycardia, a fast rhythm that starts above the ventricles
- It may be congenital, present from birth, although symptoms usually appear later in life
A WPW pattern is not the same as WPW syndrome
Sometimes patients may just have a WPW pattern on their ECG but do not suffer from WPW syndrome. In other words, the extra electrical connection can be seen on the tracing, but the person does not have irregular heart rhythms.
This distinction matters because it changes what happens next. Treatment options are based on individual cases rather than on the appearance of the ECG alone, so a pattern seen on a tracing is not automatically managed in the same way as WPW syndrome with symptoms.
If a WPW pattern has been noted on one of your recordings, it is worth discussing properly with a cardiologist so that you understand what has been found and what, if anything, needs to be kept under review.
Symptoms you may notice
Symptoms for SVTs vary widely from one person to another, and WPW is no exception. Some people are aware of every episode, while others notice very little.
Rhythm problems that affect the atria, the upper chambers of the heart, can cause a wide range of symptoms, including palpitations, shortness of breath and dizziness. These are the symptoms of atrial rhythm problems in general rather than signs that are specific to WPW.
Short bouts of SVT can be common, and can usually be treated very easily. Because episodes may be brief, it is quite normal to feel completely well again by the time you reach an appointment, which is one reason a single recording in clinic does not always capture what is happening.
- Palpitations, which people describe as racing, fluttering, pounding or a skipped beat
- Shortness of breath
- Dizziness
How Wolff Parkinson White syndrome is diagnosed
The diagnosis of heart rhythm issues is usually made through an ECG, or a Holter monitor, which is a prolonged ECG recording, to build a proper understanding of the heart rhythm. An ECG records the electrical activity of the heart through small sensors placed on the skin, and in WPW it is the test that shows the pattern created by the extra pathway.
A resting ECG takes only a few minutes and is painless. Its limitation is that symptoms may simply not occur during that short window, particularly when episodes come and go. Longer monitoring is often more useful in that situation, either continuous recording over 24 to 48 hours or longer, or an event monitor worn for longer periods and activated during symptoms.
Regular ECGs are also carried out afterwards to make sure that treatments are successful and effective.
- An ECG to record the heart's electrical activity and show the WPW pattern
- A prolonged ECG recording at home, often called a Holter monitor, when symptoms are intermittent
- Repeat ECGs to confirm that treatment is working
How Wolff Parkinson White syndrome is treated
Treatment options are based on individual cases and are personalised to the patient and the symptoms they experience. Short bouts of SVT can usually be treated very easily.
Vagal manoeuvres such as coughing or an ice pack on the face stimulate the vagus nerve, and this often relaxes and resolves the fast rhythm. Medication is also a good way to manage the condition, and the choice of medicine is one to make with your cardiologist.
If necessary, a cardioversion or an EP, or electrophysiology, study may be arranged. A DC cardioversion aims to reset the heart to its natural rhythm. Dr Jogiya will talk through which of these options fits your own pattern of episodes, and will keep the plan under review with repeat ECGs.
- Vagal manoeuvres such as coughing or an ice pack on the face, which stimulate the vagus nerve
- Medication to manage the condition, chosen and reviewed by your cardiologist
- DC cardioversion where it is needed, to reset the heart to its natural rhythm
- An EP, or electrophysiology, study if a more detailed assessment is necessary
When to seek help
Call 999 if you have chest pain, if you collapse or faint, or if someone with you becomes unresponsive. Do not wait to see whether the episode settles on its own.
Outside of an emergency, it is sensible to arrange an assessment if palpitations are frequent or getting worse, if they happen during physical exertion, if they last for prolonged periods, or if they occur alongside dizziness, breathlessness or faintness. It is also reasonable to seek advice simply because an episode felt different from anything you have experienced before.
Dr Jogiya will usually start with a detailed history of your symptoms and an ECG, and where episodes come and go he will arrange a longer monitor to capture the rhythm while it is happening. Early assessment can be reassuring when nothing serious is found, and allows treatment to be arranged in good time when it is needed.
More in arrhythmias
Related conditions he treats.
- Atrial fibrillationAtrial fibrillation, commonly known as AF, is a condition where the atria, or upper chambers of the heart, fire chaotic electrical impulses. This leads the muscle to quiver, or fibrillate, instead of beat, so the heartbeat becomes irregular and is often faster than normal. It is one of the most common heart rhythm issues and around 1.7 million people in the UK have been diagnosed with it.
- Atrial flutterAtrial flutter is a heart rhythm problem that affects the upper chambers of the heart, known as the atria. Instead of beating at a normal pace, the atria beat rapidly, but in a regular and organised pattern rather than a chaotic one. Because the chambers do not have enough time to fill properly, blood is not pumped efficiently from the top chambers to the bottom chambers, which is what leads to shortness of breath.
- Atrial tachycardiaAtrial tachycardia is a fast heart rhythm that starts in the atria, the two upper chambers of the heart. An electrical signal emerges from another section of the atria and causes a rapid repeating beat, which means the atria beat very fast. It is one form of supraventricular tachycardia, or SVT, and short bouts of it can be common.
- Bundle branch blockBundle branch block describes a block in the part of the heart's conduction system known as the bundle branches. These branches carry the electrical impulse from the AV node down to each ventricle, and when one of them is blocked the signal reaches one side of the heart before the other, so the two ventricles no longer contract in step. It is a pattern picked up on an ECG, and mostly it is something monitored rather than actively treated.
- First degree heart blockFirst degree heart block is common, and it can affect anyone at any age. It describes a delay in the electrical signal as it travels from the upper chambers of the heart to the lower chambers, rather than a true blockage. Every signal still gets through, which is why many people notice nothing at all and why the condition is usually diagnosed when testing is being done for something else.
- Second degree heart blockSecond degree heart block is a fault in the heart's electrical wiring, not a blockage in an artery. Some of the electrical signals travelling from the upper chambers of the heart fail to reach the lower chambers, so a heartbeat is occasionally missed. There are two types, known as Mobitz I and Mobitz II, and they are treated very differently.
- Sick sinus syndromeSick sinus syndrome, also called sinus node disease, is a condition where the sinus node, the small area of tissue that acts as the heart's own natural pacemaker, is not functioning properly. Sometimes the node will send an impulse as it should, and sometimes it may not fire an impulse at all, or the impulses may be out of sync. Some patients notice symptoms such as palpitations and shortness of breath, and because the node is unreliable rather than permanently stopped, those symptoms often come and go.
- Supraventricular tachycardiaSupraventricular tachycardia, usually shortened to SVT, is a fast heart rhythm that starts above the ventricles, in the upper part of the heart. Symptoms vary widely from one person to another, so some people are very aware of an episode while others barely notice one. Short bouts of SVT can be common, and can usually be treated very easily.