Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White syndrome describes when the heart beats rapidly as a result of abnormal, extra electrical pathways between the heart's two upper chambers (atria) and two lower chambers (ventricles).

Why the extra electrical pathways develop in the heart is not known. In some cases, WPW syndrome is present at birth, and WPW syndrome is the most common heartbeat disorder among infants and children. But WPW can occur at any age and develops symptoms more frequently among adults, usually between ages 30 and 40. More males than females are affected.


Diagnosis

The most common form of life-threatening heart rhythm in patients with WPW syndrome is atrial fibrillation, a condition in which the electrical activity in the heart's upper chambers (atria) becomes chaotic and very fast (300 to 400 impulses per minute). When atrial fibrillation occurs in patients without WPW, the heart's conduction system allows only a fraction of these beats to reach the ventricles.

In some cases of WPW syndrome, as many as 350 of the electrical impulses can reach the heart's lower chambers (ventricles). This interferes with the heart's ability to effectively pump blood, a life-threatening heart rhythm abnormality.

To diagnose Wolff-Parkinson-White syndrome, the patient may be asked about or tested for conditions that may trigger the abnormally fast heartbeat, such as heart disease or a thyroid problem. The patient may have two heart monitoring tests: active and passive.

Medications
Several medications can be used to manage WPW syndrome. The medications are usually taken two or three times daily.

When these medications are effective, they can prevent the need for catheter procedures or open-heart surgery. However, the medications may need to be taken for many years and can have side effects, which cause the patient not to feel well. In addition, the medications do not work for all patients and, in 2 to 8 percent of patients, aggravate rather than reduce the fast heart rate.

Open-heart Surgery
Open-heart surgery is the most effective treatment for WPW syndrome. It eliminates the extra electrical heart pathways in 96 to 99 percent of cases. However, open-heart surgery involves a seven- to 10-day stay in the hospital and four to 10 weeks of recovery at home.

Nonsurgical procedures - Atrial Fibrillation Ablation
A less-invasive alternative to open-heart surgery is catheter radiofrequency ablation. In the procedure, catheters (thin, flexible tubes) are threaded through the patient's blood vessels to reach the abnormal heart tissue. The cardiologist then uses radiofrequency energy (heat) to destroy the extra pathway.

Atrial fibrillation ablation usually requires only one to two days in the hospital. Patients usually return to normal activities within one to 10 days. The procedure is about one-third to one-half the cost of open-heart surgery.