Wolff-Parkinson-White syndrome (patient information)

For the WikiDoc page for this topic, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Kashish Goel, M.D.

Wolff-Parkinson-White syndrome is a condition characterized by abnormal electrical pathways in the heart that cause a disruption of the heart’s normal rhythm (arrhythmia). The condition can lead to episodes of tachycardia. Wolff-Parkinson-White syndrome is one of the most common causes of fast heart rate disorders in infants and children.

How often the rapid heart rate occurs depends on the patient. Some people with Wolff-Parkinson-White syndrome may have just a few episodes of rapid heart rate. Others may have the rapid heart rate once or twice a week. Sometimes there are no symptoms, and the condition is detected when a heart tests are done for another reason.

A person with WPW syndrome may have:

• Chest pain or chest tightness
• Dizziness
• Light-headedness
• Fainting
• Sensation of fluttering or pounding in the chest (palpitations)
• Shortness of breath

In rare cases, arrhythmias associated with Wolff-Parkinson-White syndrome can lead to cardiac arrest and sudden death. The most common arrhythmia associated with Wolff-Parkinson-White syndrome is called paroxysmal supraventricular tachycardia.

Normally, electrical signals in the heart go through a pathway that helps the heart beat regularly. The wiring of the heart prevents extra beats from occurring and keeps the next beat from happening too soon. In people with Wolff-Parkinson-White syndrome, there is an extra, or accessory, pathway that may cause a very rapid heart rate. This is called supraventricular tachycardia.

Mutations in the PRKAG2 gene cause Wolff-Parkinson-White syndrome. Most cases of Wolff-Parkinson-White syndrome occur in people with no apparent family history of the condition. These cases are described as sporadic and are not inherited. Familial Wolff-Parkinson-White syndrome accounts for only a small percentage of all cases of this condition.

Call your health care provider if symptoms of Wolff-Parkinson-White develop, or if you have this disorder and symptoms get worse or do not improve with treatment.

• An exam performed during a tachycardia episode will reveal a heart rate greater than 230 beats per minute and blood pressure that is normal or low. A normal heart rate is 60-100 beats per minute in adults, and under 150 beats per minute in neonates, infants, and small children.
• If the patient is currently not having tachycardia, the physical exam may be completely normal.
• A test called Electrophysiologic study may help identify the location of the extra electrical pathway.
• Wolff-Parkinson-White syndrome may be revealed by the following tests:
  • ECG (electrocardiogram) may show an abnormality called a “delta” wave.
  • Continuous ambulatory monitoring (Holter monitor).

• Medication may be used to control or prevent rapid heart beating. These include adenosine, antiarrhythmics, and amiodarone.
• If the heart rate does not return to normal with medication, doctors may use a type of therapy called electrical cardioversion.
• Therapy for Wolff-Parkinson-White syndrome also includes catheter ablation. This procedure involves inserting a tube (catheter) into an artery through a small cut near the groin up to the heart area. When the tip reaches the heart, the small area that is causing the fast heart rate is destroyed using a special type of energy called radiofrequency.
• Open heart surgery may also provide a permanent cure for Wolff-Parkinson-White syndrome. However, surgery is usually done only if the patient must have surgery for other reasons.

Patients diagnosed with wolff-Parkinson-White syndrome should avoid using the following medications:

• Eletriptan
• Frovatriptan
• Zolmitriptan
  If you have been diagnosed with wolff-Parkinson-White syndrome, consult your physician before starting or stopping any of these medications.

Directions to Hospitals Treating Wolff-Parkinson-White syndrome

Catheter ablation cures this disorder in most patients. The success rate for the procedure ranges between 85 – 95%. Success rate will vary depending on location of accessory pathway and number of accessory pathways.

Complications of Wolff-Parkinson-White syndrome can occur at any age, although some individuals born with an accessory pathway in the heart never experience any health problems associated with the condition.

• Complications of surgery
• Reduced blood pressure (caused by continous rapid heart rate)
• Heart failure
• Side effects of medications
• Ventricular fibrillation: It may rapidly lead to shock, and requires emergency treatment (cardioversion).