Wolff-Parkinson-White (WPW) syndrome is a heart rhythm problem that causes a very fast heart rate. WPW is one type of supraventricular tachycardia called atrioventricular reciprocating tachycardia (AVRT).
With WPW, an extra electrical pathway links the upper chambers (atria) and lower chambers (ventricles)
of the heart. In normal hearts, the only electrical connection between the atria and ventricles is through the AV node. The AV node helps control the heart beat. In WPW, the extra electrical pathway is called a bypass tract because it bypasses the AV node. So the AV node cannot control the heart beat, and so it beats very fast.
People with WPW can have a heart rate
of 160 to 220 beats per minute. Also,
they are more likely to have atrial fibrillation or
atrial flutter. When they do, the electrical impulses can travel down the
bypass tract and cause the heart to beat at rates of more than 250 to 300 times
per minute. This may result in fainting (syncope) or cause sudden
Many experts believe that
Wolff-Parkinson-White syndrome may in some cases be
If you have a first degree relative, which is a parent, brother, or
sister, with this disorder and he or she has symptoms, talk with your doctor
about your risk for this abnormal heart rhythm.
Symptoms include the sense of feeling the heart beat
rapidly (palpitations), lightheadedness, fainting, and dizziness.
Symptoms may start
during the teen or young adult years.
How often a person has an episode of rapid heart rate varies. A person
may have episodes of rapid heart rate once or twice a week, have rare episodes, or
never have symptoms.
Episodes of WPW can trigger a
life-threatening heart rhythm called ventricular fibrillation, although this is
extremely rare. Your doctor may recommend that you wear a medical bracelet to
alert medical professionals of your condition if you are at risk for
Doctors can often diagnose Wolff-Parkinson-White
syndrome by using an electrocardiogram (EKG or ECG). On EKG in WPW, the electrical preexcitation of the ventricles
can be seen as an abnormality on the EKG known as a delta wave. In some people
who have WPW, the accessory pathway is "concealed" and cannot be seen on an
Wolff-Parkinson-White syndrome includes medicine to control or prevent rapid or irregular heart rates.
Catheter ablation, a nonsurgical procedure, might be used to stop the rhythm problem. This procedure can
successfully eliminate WPW most of the time. There is a small risk of the
arrhythmia recurring even after successful ablation of WPW. But a second
session of catheter ablation is usually successful.
Other Works Consulted
Blomström-Lunqvist C, et al. (2003). ACC/AHA/ESC
guidelines for the management of patients with supraventricular
arrhythmias—Executive summary: A report of the ACC/AHA/ESC Committee for
Practice Guidelines. Circulation, 108(15):
Calkins H (2011). Supraventricular tachycardia: Atrioventricular nodal reentry and Wolf-Parkinson-White syndrome. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 1, pp. 987–1005. New York: McGraw-Hill.
Cohen MI, et al. (2012). PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern. Heart Rhythm, 9(6): 1006–1024.
August 9, 2012
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
& John M. Miller, MD, FACC - Cardiology, Electrophysiology
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