Wolff Parkinson White Syndrome

Overview

Wolff-Parkinson-White (WPW) syndrome is a heart condition that you are born with. It means you have an extra electrical pathway in your heart that can cause a sudden very fast heartbeat. This can make you feel dizzy, short of breath, or like your heart is racing. Many people with WPW have no symptoms and only find out about it by accident.

WPW is not common. It affects roughly 1 to 3 people in every 1,000 worldwide.

It can affect anyone, from newborn babies to older adults. Many people are first diagnosed as teenagers or young adults when they notice their heart beating fast. It is present at birth, but symptoms may not appear until later.

Symptoms

Common symptoms

• A feeling that your heart is racing, fluttering, or skipping a beat
• Dizziness or lightheadedness
• Shortness of breath
• Chest discomfort or a feeling of tightness
• Unusual tiredness
• Sweating for no clear reason

Symptoms in children

• Fast heartbeat that comes and goes
• Being irritable or restless without an obvious reason
• Poor feeding or sucking slowly
• Pale skin or sweating
• Tiredness or less energy than usual

Symptoms in older adults

• Sudden heart racing that may last a few seconds to several minutes
• Breathlessness with mild activity
• Chest pain or pressure
• Fainting or feeling like you might faint
• Fatigue that is worse than usual

Causes

Main causes

• The exact cause is a small band of extra heart muscle that creates a 'shortcut' for electrical signals.
• This shortcut lets electrical signals travel too quickly and can make the heart beat abnormally fast.
• It is usually present from birth, so it is not caused by something you did or did not do.

Risk factors

• Being born with a heart defect called Ebstein anomaly (a rare problem with the heart's tricuspid valve)
• Having a family history of heart rhythm problems
• Having other congenital heart conditions, although this is uncommon

When to see a doctor

See a doctor urgently if:

• If you have episodes of a very fast heartbeat that leave you breathless or dizzy, seek medical advice promptly.
• If you have chest pain, fainting, or severe shortness of breath, go to an emergency department immediately.

Book a routine appointment if:

• If you have occasional palpitations (a racing or fluttering feeling) and you have not been checked before, make a routine appointment with your doctor.
• If you already know you have WPW and your symptoms change or happen more often, tell your heart specialist.

Diagnosis

WPW is diagnosed with a painless test called an electrocardiogram (ECG). An ECG records the electrical activity of your heart. Your doctor may also ask about your symptoms and order more tests if the ECG is not clear.

Tests that may be done

• Electrocardiogram (ECG) – a quick test that checks your heart's electrical signals
• Holter monitor – a small portable ECG device you wear for 24 hours to catch episodes of fast heart rhythm
• Event recorder – a device you wear for weeks or months, activated only when you feel symptoms
• Electrophysiological study (EP study) – a specialist test done in hospital to map the heart's electrical pathways in detail

What to expect at your appointment

If your doctor thinks you might have WPW, you will usually be referred to a cardiologist (heart specialist). The specialist will explain the test results and talk with you about whether you need any treatment. This is usually done as an outpatient, meaning you do not have to stay in hospital overnight.

Treatment

Treatment for WPW depends on your age, how often you have symptoms, and whether the fast heartbeats are dangerous. Many people need no treatment at all. Others may be offered medication or a simple procedure to stop the extra electrical pathway from causing symptoms.

Self-care at home

• Avoid drinking too much caffeine, especially energy drinks
• Limit alcohol, as it can trigger heart palpitations
• Learn simple relaxation techniques to help manage stress and anxiety
• If your doctor teaches you special breathing or 'vagal maneuvers' to slow your heart rate, you can use them when episodes happen
• Always follow the advice your heart specialist gives you about how to stay safe

Medical treatments

To control episodes of fast heartbeat, a doctor may prescribe medicines that help regulate the heart's electrical signals. These medicines do not cure WPW, but they can make episodes shorter, less frequent, or less intense. Only a qualified doctor can decide if medication is right for you, and all medicines have possible side effects, so your doctor will review this carefully.

When is surgery considered?

The most common treatment for WPW is a procedure called catheter ablation. In this procedure, a doctor passes a thin tube into a blood vessel and guides it to the heart. The doctor then uses heat or cold to destroy the extra pathway. It is a fairly quick procedure and can often cure WPW completely. You will need a referral to a specialist heart centre to find out if you are a good candidate.

Living with this condition

Most people with WPW can live exactly as they used to. The key is to learn your own triggers and let your doctor support you. Keep track of any symptoms you get and mention them at your next appointment.

Lifestyle tips

• Get enough rest and avoid staying up late repeatedly
• Keep your stress levels down with hobbies, gentle activity, or relaxation exercises
• Stay hydrated, especially on hot days or during exercise
• Do not ignore warning signs – if your heart feels unusual, follow the plan you made with your doctor

Diet and exercise

A balanced diet of fruit, vegetables, whole grains, and lean protein is good for your heart. Exercise is usually safe and recommended for most people with WPW, but before starting a new sport or intense workout, ask your doctor or specialist what level is right for you.

Mental health and emotional wellbeing

Living with any heart rhythm condition can cause worry and anxiety. It is normal to feel concerned when your heart suddenly races. Do not bottle these feelings up. Talk to your doctor, a trusted friend, or a counsellor. You are not overreacting – it is a real concern, and emotional support is part of good care.

Prevention

Because WPW is something you are born with, it cannot be prevented. However, for people who do get symptoms, treatment can often prevent future episodes. You can also reduce your chances of triggers by keeping your lifestyle heart-healthy, such as limiting stimulant drinks and managing stress.

Screening programmes

If someone in your family has WPW or another heart rhythm problem, tell your doctor. They may suggest checking your heart with an ECG. Routine screening for everyone is not recommended, but you can be tested if you have any symptoms that could be related.

Complications

If left untreated

• Without treatment, some people continue to have episodes of very fast heartbeat, which can be frightening and affect daily life.
• Rarely, a very fast rhythm called atrial fibrillation can happen and may lead to a dangerous heart rhythm. This is uncommon, but it is one reason why medical assessment is important.
• Fainting can occur during a fast episode if your blood pressure drops quickly.

Long-term outlook

The outlook is very good. Most people with WPW lead normal, active, and healthy lives. If you do need treatment, modern care is safe and effective. Even without symptoms, it is wise to stay in touch with your doctor so any changes can be looked at early. You are not defined by this condition – with the right information and support, you can manage it well.

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