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Wolff-Parkinson-White (WPW) Syndrome

Medically reviewed by Sandeep Dhanyamraju

Wolff-Parkinson-White syndrome is a violation of the process of excitation of the ventricles, in which there is an increase in the heart rate.

Normally, the pulse wave travels from the atria to the ventricles through the atrioventricular node and the bundle of His. With this pathology, secondary conduction pathways are formed, called the Kent beam, which is characterized by different electrophysiological properties and therefore conducts excitation faster. In this case, the wave of depolarization propagates in different directions from the atria to the ventricles and is called a delta wave. As a result, premature excitation and contraction of the ventricles occur. One of the signs of this syndrome is the manifestation of paroxysmal tachycardia, atrial fibrillation (flutter), supraventricular extrasystole.

 

Diseases in which WPW occurs:

  • hypertrophic cardiomyopathy;
  • supraventricular tachycardia;
  • congenital heart defects – atrial septal defect, tetralogy of Fallot, mitral valve prolapse, Ebstein’s anomaly;
  • atrial flutter;
  • connective tissue dysplasia syndrome;
  • and atrial fibrillation. 

 

These diseases disrupt the normal structure of the heart and the proper functioning of the conducting system. And tachyarrhythmias provoke a decrease in myocardial contractility and expansion of the atria and ventricles.

At the same time, 70% of people who have a Kent bundle in the cardiac conduction system do not have symptoms of cardiac diseases. Premature ventricular contraction syndrome most often occurs if you have another organic heart disease.

 Symptoms Wolff-Parkinson-White syndrome

Symptoms and Diagnosis of Wolff-Parkinson-White (WPW) Syndrome

 

Symptoms of Wolff-Parkinson-White (WPW) syndrome:

  • a sudden attack of palpitations;
  • interruptions in the work of the heart;
  • throbbing in the head or throat;
  • general weakness, dizziness, decreased exercise tolerance, and increased fatigue during an attack;
  • loss of consciousness is possible;
  • dyspnea;
  • against the background of an attack, dizziness or loss of consciousness may develop;
  • decrease in blood pressure (arterial hypotension or unstable blood pressure).

 

Diagnosis of the Wolff-Parkinson-White (WPW) Syndrome

In the majority of cases, it can proceed latently and not be detected on the ECG if a person maintains a normal sinus rhythm.

 

WPW can be diagnosed at any age during Doppler echocardiography (EchoCG) – an ultrasound examination of the heart.

  1. This method allows you to visualize structural and functional changes in the myocardium. 
  2. Only echocardiography can provide complete information about the nature of arrhythmia and its effect on cardiac function. 
  3. Ultrasound of the heart allows you to see both morphological and functional disorders and identify congenital defects and deformities. 
  4. With this method, it is possible to assess the speed, direction, and nature of blood flow and predict the development of myocardial ischemia.
  5. EchoCG with color Doppler is non-invasive and does not use ionizing radiation, plus it has no harmful effects. 
  6. It provides the most comprehensive information about the structure and function of the heart.

 

Causes of Wolff-Parkinson-White syndrome

Causes and Classification of Wolff-Parkinson-White Syndrome

Possible and predisposing causes:

  • congenital valvular defects (mitral valve prolapse, tricuspid valve prolapse, accessory chords, open foramen ovale);
  • hereditary predisposition;
  • systemic connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome).

 

The main types of this syndrome are:

  1. Manifest WPW syndrome is established in patients with delta wave ECG and tachyarrhythmias. The most common arrhythmia among patients with WPW syndrome is atrioventricular reciprocal tachycardia (AVRT). The term “reciprocal” is synonymous with the term “re-entry” – the mechanism of tachycardia.
  2. Latent WPW syndrome is established if, with sinus rhythm, the patient has no signs of ventricular pre-excitation (the PQ interval is normal, there are no signs of a delta-wave), but tachycardia is observed (AVRT with retrograde conduction along the VVP).
  3. Multiple WPW syndrome is established if 2 or more DPWDs are verified that are involved in maintaining re-entry in AVRT.
  4. Intermittent WPW syndrome is characterized by transient signs of ventricular preexcitation against the background of sinus rhythm and verified AVRT.
  5. WPW phenomenon. Despite the presence of a delta wave on the ECG, some patients may have no arrhythmia. In this case, the WPW phenomenon is diagnosed (not WPW syndrome).

 

Only one-third of asymptomatic patients under the age of 40 who have ventricular preexcitation syndrome (delta wave) on the ECG eventually develop signs of arrhythmia. At the same time, none of the patients with ventricular preexcitation syndrome, first diagnosed after the age of 40, developed arrhythmia.

 

Most asymptomatic patients have a good prognosis; cardiac arrest is rarely the first manifestation of the disease. The need for endo-EPI and RFA in this group of patients is controversial.

Treatment of Wolff-Parkinson-White syndrome

Treatment of Wolff-Parkinson-White syndrome

Initial care for an episode of orthodromic AVRT consists of vagal techniques:

  • Vagus tests: Valsalva test (straining at the height of inspiration), massage of the carotid sinus (unilateral pressure in the area of ​​the carotid triangle for no more than 10 s), cough and vomiting reflexes, and putting ice pieces on the face. The effectiveness of vagal tests with supraventricular tachycardia reaches 50%.

 

  • If a patient has Wolff-Parkinson-White (WPW) syndrome, the physician may choose not to use adenosine because it can induce AF; you can use propafenone or procainamide instead.

 

  • Alternatively, external electrical cardioversion can be performed immediately. With hemodynamically significant symptoms against the background of AVRT (syncope, presyncope, angina pectoris, hypotension, increased signs of cardiac insufficiency), immediate external electrical cardioversion (100 J) is indicated. If there are no associated risk factors for systemic embolization, electrical cardioversion does not require anticoagulation.

 

  • In patients with tachycardia with WPW syndrome, drugs acting on the AV node should not be used. The use of β-blockers, calcium channel blockers, and cardiac glycosides is contraindicated because they slow down the conduction along the AVU and do not affect the conduction of the anterograde along the DPZH or even intensify it. It is dangerous to the transformation of AVRT into ventricular tachycardia and/or VF.

 

Catheter ablation (Radiofrequency Ablation or RFA) for treatment of Wolff-Parkinson-White syndrome

 

In the majority of cases, the primary efficacy of catheter ablation of the RPV was approximately 95%. The efficiency of catheter ablation of the VVD located in the lateral wall of the left ventricle is slightly higher than that of catheter ablation of additional pathways of other localization. Recurrences of conduction along the RPVS occur in approximately 5% of cases, which is associated with a decrease in edema and inflammatory changes caused by the damaging effect of RF energy. Repeated RFA usually eliminates the conduction of the VAD.

 

Complications during endo-EPI and RFA of additional pathways can be divided into 4 groups:

  1. Complications due to radiation exposure.
  2. Complications associated with a puncture and vascular catheterization (hematoma, deep vein thrombosis, arterial perforation, arteriovenous fistula, and pneumothorax).
  3. Complications during catheter manipulations (damage to heart valves(heart disease), microembolism, perforation of the coronary sinus or myocardial wall, dissection of coronary arteries, and thrombosis).
  4. Complications caused by RF exposure (arterioventricular block, myocardial perforation, spasm or occlusion of the coronary arteries, transient cerebrovascular accident, and cerebrovascular complications).

 

Mortality associated with the ablation procedure for accessory pathways does not exceed 0.2%.

 

Complete AV block and cardiac tamponade are serious complications. The incidence of irreversible complete AV blocks ranges from 0.17% to 1.0%. The frequency of cardiac tamponade varies from 0.13% to 1.1%.

preventions of Wolff-Parkinson-White Syndrome

Prognosis, risks, and preventions of Wolff-Parkinson-White (WPW) Syndrome

 

Prognosis of Patients with WPW Syndrome

In only 1% of cases, WPW syndrome can lead to life-threatening ventricular fibrillation. 

  1. If there is a risk, surgical treatment is recommended – intracardiac radiofrequency ablation. 
  2. But not all patients need it. For most people, Wolff-Parkinson-White syndrome has a comforting prognosis and is mild. 
  3. They take antiarrhythmic drugs as prescribed by a doctor for the prevention and relief of tachycardia paroxysms.

 

The Risks of WPW Syndrome

The main consequences are:

  1. The WPW syndrome, manifested by attacks of tachycardia, reduces the patient’s quality of life. 
  2. Loss of consciousness during paroxysms can lead to serious injuries and accidents.
  3. Reciprocal AV tachycardias in WPW syndrome are classified as pre-fibrillatory arrhythmias. 
  4. Frequent attacks of the disease can lead to more dangerous and complex atrial fibrillation, which can transform into ventricular fibrillation and lead to death.

 

Prevention of Wolff-Parkinson-White (WPW) Syndrome

There is no specific prevention of the disease. If an ECG reveals WPW syndrome in a patient, they should be regularly examined by a cardiologist (even if they are not worried about the symptoms). If signs of pathology appear, you need to choose the right treatment immediately.

 

Persons who are related to a patient with WPW syndrome are advised to undergo a routine examination to exclude the development of this pathology. Diagnostics should include daily monitoring of the electrocardiogram, electrocardiogram, and electrophysiological methods.

 

 

FAQs

  • What kind of disease causes the attack of heartbeat, the interruptions in the work of the heart and throbbing in the head or throat?

Wolff-Parkinson-White syndrome is a violation of the process of excitation of the ventricles, in which there is an increase in the heart rate.

  • Is it possible to do surgery for arrhythmias?

An operation for the treatment of cardiac arrhythmias (atrial fibrillation and other forms) is prescribed exclusively by a doctor and only after the necessary examination has been carried out. This makes the procedure not only effective but also safe for the patient.

  • What is Wolff-Parkinson-White transient syndrome?

Intermittent WPW syndrome is characterized by transient signs of ventricular preexcitation against the background of sinus rhythm and verified AVRT. WPW phenomenon. Despite the presence of a delta wave on the ECG, some patients may have no arrhythmia. In this case, the WPW phenomenon is diagnosed (not WPW syndrome).

  • How to stop an arrhythmia attack?

Paroxysms of atrial reciprocal tachycardia, verapamil, beta-blockers, amiodarone or digoxin, and EIT can be used to stop attacks and slow down the heart rate. Automatic and chaotic atrial tachycardias often require not an emergency but planned therapy.

  • How to take Cordarone during an arrhythmia attack?

In the treatment of ventricular arrhythmias, the initial saturating dose of Cordarone should be 800-1600 mg/day (more often separately) for 2-3 weeks. Then the dose can be reduced to 400-600 mg/day. Such a treatment regimen most often ensures the achievement of a stable concentration of the drug in this category of patients.

  • Can you do sports with the Wolff-Parkinson-White syndrome phenomenon?

If athletes have WPW syndrome, an in-depth clinical and physiological examination is necessary. If at the same time, abnormalities from the cardiovascular system are not detected, then WPW syndrome is not a reason for prohibiting sports.

  • How does Wolff-Parkinson-White syndrome differ from a phenomenon?

The difference is that the patient learns about the existing WPW phenomenon only from the words of the doctor, who discovers characteristic signs on the ECG. They never feel any changes associated with the peculiarity of their heart. In turn, WPW syndrome provokes an arrhythmia attack in the patient.

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Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
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Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
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Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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