Wolff - Parkinson - White syndrome WPW: what is it and what is it caused by?

By Cristiano Antonino On Jun 24, 2023

Wolff – Parkinson – White syndrome – henceforth referred to as WPW syndrome for short – is a particular form of supraventricular tachycardia in which, in addition to the normal conduction circuit of the heart rhythm, an accessory conduction bundle is also involved, which, in sufferers, is present from birth

During foetal life, i.e. when the heart is forming, the cardiac atria are connected to the ventricles by numerous rhythm conduction bundles that physiologically disappear after birth; all except one: the His bundle.

In some cases, however, some of these accessory bundles may persist abnormally and be responsible for episodes of tachycardia as a child, or even a newborn, precisely because this accessory bundle is of congenital origin.

Under normal, physiological conditions, the electrical impulse of the heartbeat from the atria to the ventricles is one-way, i.e. it travels along a single pathway consisting of the atrio-ventricular node and bundle of His.

This node has such characteristics that it is able to protect the ventricles – as if it were a filter – from too rapid and potentially dangerous atrial impulses.

In the case of WPW syndrome, there are so-called ‘accessory’ conduction pathways between the atria and ventricles, located at various sites of the tricuspidal and mitral valve rings, which do not perform the previously mentioned ‘filtering’ task, causing abnormal impulses to reach the ventricles at even very high frequencies.

WPW (Wolff – Parkinson – White) syndrome: how to recognise the symptoms

WPW syndrome can be responsible for the onset of paroxysmal supraventricular tachycardia.

When a child is affected by this syndrome, he or she is at high risk of developing cardiac arrhythmias, the most common symptoms of which include the appearance of specific symptoms such as a feeling of breathlessness or shortness of breath, but also general symptoms such as unusual drowsiness or loss of appetite; these young patients may also present with rapid and visible chest pulsations due to the abnormal and irregular heartbeat. In some cases, the condition may be complicated by the development of heart failure.

However, the disease is not always noticed as early as in childhood: those with WPW syndrome can enjoy good health for years.

In adolescents and adults, WPW syndrome tends to manifest itself around the age of 20 with cardiac arrhythmias: patients may complain of palpitations that usually begin suddenly during exercise.

These may only last for a few seconds, or they may persist for many hours after the effort has stopped.

If the palpitations are particularly persistent and characterised by a very high heart rate, they could also be responsible for the patient’s fainting episodes.

The palpitations felt by the patient are the result of very rapid impulses from the atria in the direction of the ventricles, which are transmitted at a much faster rate than normal.

So rapid that it can be potentially fatal. This is not only because the heart is inefficient when beating so fast, but also because such an accelerated heart rate could turn into ventricular fibrillation, which tends to be fatal, especially if not treated in a timely manner.

Diagnosing Wolff-Parkinson-White syndrome

When a patient – or, in the case of very young patients, the patient’s relatives – begins to notice some of the above-mentioned symptoms, it is a good idea to quickly contact a cardiologist specialist, so that – in the case of WPW syndrome – the most appropriate treatment can be carried out immediately.

During the examination, the cardiologist will first of all proceed with a thorough anamnesis of the patient in order to point out other possible suspicious symptoms that have gone unnoticed by the patient or his family members.

Becoming aware of the patient’s medical history or family history may be helpful in facilitating or speeding up the diagnosis.

The suspicion of WPW syndrome can be easily confirmed by performing a simple electrocardiogram because, unlike other types of tachycardia, this syndrome has specific ECGraphic signs.

If the electrocardiogram reports the presence of alterations typical of WPW syndrome, the cardiologist generally also recommends performing an electrophysiological study, which can provide more precise information on the conductive capacity of the accessory bundle, such as the location of the accessory pathway.

Wolff – Parkinson – White syndrome: the most appropriate therapy

The most frequently recommended therapies for the treatment of Wolff – Parkinson – White syndrome can range from performing manoeuvres and prescribing drugs that aim to convert the heart rhythm, i.e. to make it normal, to procedures such as ablation, in cases where it is deemed necessary.

In the presence of WPW syndrome with episodes of paroxysmal supraventricular tachycardia, the effectiveness of certain vagal manoeuvres that – by stimulating the vagus nerve – reduce the heart rate has been studied and confirmed.

These manoeuvres are particularly effective if they are performed at the time when the tachycardia episode begins.

If manoeuvres alone are not sufficient, they could be combined with drug therapy based on anti-arrhythmic drugs such as Verapamil or Adenosine or Digoxin in prepubertal children, in order to put an end to the arrhythmia.

This drug therapy can – always under the close supervision of one’s cardiologist – be taken as chronic therapy with the aim of keeping episodes of tachycardia under control.

If these therapies are not sufficient to control the pathology, it may be necessary to resort to ablation by means of a catheter inserted into the heart, i.e. the partial destruction of the accessory pathway by delivering energy at a specific frequency.

A positive outcome of this method has been recorded in 95% of cases; this procedure is also recommended for young patients in order to avoid the need for antiarrhythmic drug therapy for the rest of their lives.

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