Wolff (Wolfe)-Parkinson-White Syndrome (WPW)
Wolff-Parkinson-White (WPW) results from an additional electrical connection between the upper chambers of the heart (atria) and the lower chambers of the heart (ventricles). This extra or ‘accessory’ pathway is seen in approximately 1 in every 300-500 people and sometimes it allows conduction of the electrical pulse at high speed, generating an electrical short circuit, which produces a rapid heart rate (arrhythmia) which can occasionally be dangerous. WPW is rarely inherited, however, and runs in families in less than 1% of cases.
People with WPW may never experience symptoms. In fact, in the majority of people the extra pathway is completely silent. Palpitations are, however, the main symptom of WPW. Some people may find these palpitations untroubling, but in others they may cause chest pain, light-headedness and even blackouts. They may occur predictably or at any time and people may be able to control them. One way of doing this is by holding one’s breath as forcibly as possible. The palpitations may remain, however, until they can be stopped by an injection in an accident and emergency department.
How is Wolff (Wolfe)-Parkinson-White diagnosed?
WPW is diagnosed on an ECG. It is often found during a routine ECG check as part of medical insurance or cardiovascular screening, or detected when testing for palpitations. Other tests may include an ECHO, an exercise ECG and a 24-hour Holter monitor (tape).
If a person is a competitive athlete; or has a particular job such as a pilot or a soldier; or has had palpitations because of arrhythmia; more invasive tests (EP studies) may be recommended to assess the way the accessory pathway behaves and therefore the risk of significant arrhythmias.
Tablets would be the first line option if WPW manifests with repetitive palpitations.
The ideal treatment for someone with symptoms of WPW is to burn the extra electrical pathway using RF ablation. This is usually considered if symptoms of palpitations are not well controlled on tablets. This is done at the time of an EP study, by passing a wire into the heart and locating the pathway. This is destroyed by passing a high current through it. This takes approximately 1-2 hours and may require one night in hospital.