How Is Wpw Syndrome Treated
If youre diagnosed with WPW syndrome, you have several treatment options, depending on your symptoms. If youre diagnosed with WPW syndrome but dont have any symptoms, your doctor may recommend that you wait and continue follow-up appointments. If youre having symptoms, the treatment may include the following:
How Is Wpw Treated
Treatment depends on the type and frequency of arrhythmias, associated symptoms such as syncope, and presence of structural heart disease. Typically a physician will recommend an ablation procedure to further define the characteristics of the accessory pathway, and ultimately, to eliminate the pathway entirely.
- Observation – If you have no symptoms, you may not require treatment. Your doctor may choose to have regular follow-up without treatment.
- Medications – A variety of drugs are available to treat arrhythmias. Because everyone is different, it may take trials of several medications and doses to find the one that works best for you. It is important to know:
- The names of your medications
- What they are for
- How often and at what times to take them
Common Symptoms For These People *:
* Approximation only. Some reports may have incomplete information.
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Wolff Parkinson White Syndrome
Synonyms of Wolff Parkinson White Syndrome
- Accessory Atrioventricular Pathways
- WPW Syndrome
Wolff-Parkinson-White syndrome is a rare congenital heart disorder involving irregularities in the electrical system of the heart. In individuals with WPW syndrome, an abnormal alternate electrical pathway , exists between the atrium and the ventricle, resulting in abnormal heartbeat rhythms and faster than normal heartbeats .
The normal heart has four chambers. The two upper chambers are the atria and the two lower chambers are the ventricles. Within the right atrium of a normal heart is a natural pacemaker that initiates and controls the heartbeat. The electrical stimulus travels from the pacemaker to the ventricles along a specific pathway consisting of conducting tissue and known as the AV node. The extra electrical pathway in individuals with WPW syndrome bypasses the normal route and causes the ventricles to beat earlier than normal and can allow electrical impulses to be conducted in both directions .
Signs & Symptoms
The symptoms associated with WPW syndrome vary greatly from case to case. Some individuals may not have any abnormal heartbeats or associated symptoms . Although the disorder is present at birth , symptoms may not become apparent until adolescent or early adulthood.
Symptoms of the following disorders can be similar to those of WPW syndrome. Comparisons may be useful for a differential diagnosis.
What Are The Effects Of This Problem On My Child’s Health
The information about supraventricular tachycardia applies to children with WPW. In babies, the problem resolves on its own about 50% of the time.
Rarely, WPW can cause sudden cardiac death. This can occur only if 1) the extra pathway can conduct an electrical signal very quickly from the atria to ventricles and 2) the person has an arrhythmia called atrial flutter/fibrillation. In atrial fibrillation/flutter, the upper chambers of the heart beat very fast, from 300 to 600 beats per minute. If the pathway can conduct very rapidly to the lower chambers , it could result in a life-threatening heart rhythm called ventricular fibrillation. In patients without WPW, the ventricles are protected from the fast atrial rates by the AV-node since is can only conducts a fraction of the signals . Sudden cardiac death from WPW is extremely rare in the first few years of life.
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Managing Episodes Of Supraventricular Tachycardia At Home
Its important that you are able to recognise the potential signs and symptoms of SVT and we will teach you how to do this. If appropriate, we will also teach you and your child vagal manoeuvres which can include blowing in a straw or a balloon. These work on the vagal nerve which regulates the heartbeat.
Most episodes of supraventricular tachycardia only last for a few minutes and do not need urgent treatment. Some episodes may last longer and children may be affected by these. If an episode is prolonged or the person experiences any of the red flag symptoms, they should be taken to the nearest Accident and Emergency department immediately.
The doctors will try some ‘tricks’ to try to slow the heart such as blowing into a syringe, if these are not successful or the SVT is causing other concerns such as low blood pressure, they may use a medication. As a last resort, a shock can be given as a life-saving option.
Wolff Parkinson White Syndrome Symptoms
People of all ages, including infants, can experience the symptoms related to Wolff Parkinson White syndrome.
If you have Wolff Parkinson White syndrome, youll experience episodes where your heart suddenly starts racing, before stopping or slowing down abruptly. This rapid heart rate is called supraventricular tachycardia .
Symptoms of Wolff Parkinson White syndrome are the result of a fast heart rate. They most often appear for the first time in people in their teens or 20s.
Common symptoms of Wolff Parkinson White syndrome include:
- Sensation of rapid, fluttering or pounding heartbeats
- Dizziness or lightheadedness
Signs and symptoms in infants with WPW syndrome may include:
- Ashen color
- Rapid breathing
- Poor eating
An episode of a very fast heartbeat can begin suddenly and last for a few seconds, minutes or several hours. Rarely, they can last for days. Episodes can occur during exercise or while at rest. Caffeine or other stimulants and alcohol may be a trigger for some people.
How often they occur varies from person to person. Some people may have episodes on a daily basis, while others may only experience them a few times a year.
They normally occur randomly, without any identifiable cause, but they can sometimes be triggered by strenuous exercise or drinking a lot of alcohol or caffeine.
If youve already been diagnosed with WPW syndrome and you experience an episode, first try the techniques youve been taught or take any medication youve been given .
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Prevalence Symptoms And Prognosis Of Wpw Syndrome
An electrocardiographic pattern of preexcitation occurs in the general population at a frequency of around 1.5 per 1000. Of these, 50% to 60% of patients become symptomatic. Approximately one-third of all patients with paroxysmal supraventricular tachycardia are diagnosed as having an AP-mediated tachycardia. Patients with AP-mediated tachycardias most commonly present with the syndrome of PSVT.
Population-based studies have demonstrated a bimodal distribution of symptoms for patients with preexcitation, with a peak in early childhood followed by a second peak in young adulthood. Nearly 25% of infants who demonstrate preexcitation and/or have AP-mediated arrhythmias will lose evidence of preexcitation and/or become asymptomatic over time as the conduction property of the AP can degenerate with time.
Pappone et al reported that during a mean follow-up of 37.7 months, 18.2% and 30% of noninducible patients have lost the anterograde and retrograde conduction, respectively. The mean age of these patients was 33.6 ± 14.3. Compared to others who had persistent conductibility through the AP, these patients were asymptomatic, noninducible, and had longer minimal 1:1 conduction cycle length through the AP during the baseline EPS.
How To Manage Or Live With Wpw
There is no way to prevent WPW, but you can prevent complications by learning as much as you can about the disease and working closely with your cardiologist to find the best treatment. Ask your doctor to teach you how to do a Valsalva maneuver.
Here are helpful lifestyle suggestions:
Work with your doctor to keep conditions such as high cholesterol and high blood pressure under control.
Eat a heart-healthy diet.
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Treatment For An Extra Electrical Pathway In The Heart
Wolff-Parkinson-White syndrome, or WPW syndrome, is a problem with the way electrical signals travel through the heart. Normally, these signals travel from the top of the heart to the bottom through a single electrical connection. If you have WPW syndrome, your heart has an extra pathway, or connection, and signals can either travel down both paths at the same time or create a rapid regular or irregular rhythm. In rare instances, these rhythm disorders can be associated with life-threatening problems.
WPW syndrome is a heart condition thats present from birth and puts patients at greater risk for problems with their hearts rhythms. Our electrophysiology program is the regions leading referral program for heart rhythm disorders and can treat even the most complex conditions.
What Are The Long
Overall, the outlook for children with WPW is excellent. The problem resolves in the majority of infants by 12 months of age although SVT may recur later in childhood.
When the problem persists, radiofrequency ablation has proven to be safe and effective.
Exercise guidelines: Guidelines are best made by a patients doctor so that all relevant factors can be included. Participation in vigorous competitive sports may be restricted until the problem is treated by radiofrequency ablation. If the pathway does not conduct rapidly , usually no activity restrictions are needed .
If an episode of SVT occurs during sports, the child should remove herself/himself from participation until the arrhythmia is converted. Also, activities that involve climbing heights should be avoided since an episode may cause dizziness leading to a fall.
Bolling S, Morady F, Caukins H, Kadish A, de Buitleir M, Langberg J, Dick M, Lupinetti F, Bove E. Current treatment for Wolff-Parkinson-White syndrome: results and surgical implications. Ann Thor Surg. 52:461-468,1991.
Deal B, Dick M, Beerman L et al. Cardiac arrest in young patients with Wolff-Parkinson-White syndrome. PACE 1995 18:815.
Dick M, O’Connor B, Serwer G, LeRoy S, Armstrong B. Use of radiofrequency energy to ablate accessory connections in children. Circulation 84:2318-24, 1991.
Reviewed September, 2012
Home Remedies: Vagal Maneuvers
Sometimes, a persons rapid heartbeat corrects itself. Alternatively, some simple physical movements may help to correct the heartbeat.
These exercises include:
- bearing down as if having a bowel movement
- massaging the sides of the neck over the carotid artery
- holding an ice pack on the face
- gagging or forceful coughing
Therapists call these exercises vagal maneuvers because they affect the vagus nerve that runs from the abdomen to the brain. A branch of it runs to the heart.
Stimulation of the vagus nerve can cause a variety of results, depending on what organ it affects. If the heart is beating too fast, it acts as a brake and slows the heart rate down.
If vagal maneuvers do not normalize the heart rhythm, a doctor may inject an antiarrhythmic drug to bring the heartbeat back to normal.
Another option is a procedure known as cardioversion. This intervention is when a doctor places paddles or patches on the persons chest and applies an electric shock to the heart, to restore normal heart rhythm.
Doctors usually use cardioversion for people who have not responded to vagal maneuvers or medication.
Further Information And Support
You can get in touch with the Arrhythmia Service on extension 5298, email them on or contact them via MyGOSH once you have registered. More information about MyGOSH is at www.gosh.nhs.uk/your-hospital-visit/mygosh
There are various organisations in the UK that support people with heart problems.
The biggest is the British Heart Federation their helpline is on or you could visit their website at www.bhf.org.uk
SADS UK can also offer help and support call them on or visit their website at www.sadsuk.org.
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Wolff Parkinson White Syndrome Causes
When the heart beats, its muscular walls contract to force blood out and around the body. They then relax, allowing the heart to fill with blood again. This is controlled by electrical signals.
In Wolff Parkinson White syndrome, theres an extra electrical connection in the heart, which allows electrical signals to bypass the usual route and form a short circuit. This means the signals travel round and round in a loop, causing episodes where the heart beats very fast.
The extra electrical connection is caused by a strand of heart muscle that grows while the unborn baby is developing in the womb.
Its not clear exactly why this happens. It just seems to occur randomly in some babies, although rare cases have been found to run in families.
Wolff Parkinson White is more common in males than in females.
How Is This Problem Diagnosed
Clinical features: See Supraventricular tachycardia.
Physical findings: Most of the time the physical examination is normal when the child is not having an episode. In about 15% of children, the problem is associated with a heart defect. In this case the child has physical findings associated with that defect.
Medical tests: One of the first tests usually done is an electrocardiogram. This is a safe a painless test that involves putting some stickers across the chest. The stickers are connected to a machine that records the hearts electrical activity. In WPW, the resting ECG shows pre-excitation. This finding is quite specific for WPW and helps to confirm the diagnosis. Sometimes, pre-excitation is found on a routine ECG in a person who has no symptoms.
It may be important to record an ECG at the time of symptoms. This is done by device called a transtelephonic ECG recorder. There are different models of these devices available, but they are all able to record an ECG at the time of symptoms. The tracing can then be sent over the phone to a cardiology center where it can be reviewed. Other tests that may be done include a Holter monitor, echocardiogram, and/or exercise test.
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How Can We Tell The Location Of The Ap Based On The Superficial 12
The ECG hallmark of an antegradely conducting AP is the delta wave along with a shorter than usual PR interval and a widened QRS complex. Conversely, the presence of retrograde conduction only in an AP will not be apparent on a surface ECG during sinus rhythm . Whereas ECG during ORT has a normal QRS complex with retrogradely conducting P wave after the completion of the QRS complex in the ST segment or early in the T wave, the QRS during ART is fully preexcited.
Numerous algorithms have been described to localize the site of the AP using the axis of the delta wave and QRS morphology. The location of the AP along the AV ring is classified variously into five or ten regions, which can be broadly divided into those on the left and the right of the AV groove. Distribution along these lines is not homogenous. Some 46% to 60% of the pathways are found on the left free wall space. Nearly 25% are within the posteroseptal and midseptal spaces, 15% to 20% in the right free wall space, and 2% in the anteroseptal space.
The positive predictive value of these algorithms is better when the delta wave polarity is included and when algorithms involve fewer than six locations. Two simple algorithms that include both the delta wave axis and the QRS axis are shown . For the purpose of localization of the APs, delta wave is defined as the first 20 ms of the earliest QRS deflection.
Normal Heart Electrical System
Your heart is made up of four chambers two upper chambers and two lower chambers . The rhythm of your heart is normally controlled by a mass of tissue in the right atrium . The sinus node produces electrical impulses that generate each heartbeat.
These electrical impulses travel across the atria, causing muscle contractions that pump blood into the ventricles. The electrical impulses then arrive at a cluster of cells called the atrioventricular node usually the only pathway for signals to travel from the atria to the ventricles. The AV node slows the electrical signal before sending it to the ventricles.
This slight delay allows the ventricles to fill with blood. When electrical impulses reach the ventricles, muscle contractions pump blood to the lungs and the rest of the body.
Figure 1. The hearts electrical system
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Management Of Asymptomatic And Symptomatic Preexcitation
Blomström-Lundqvist, C, Scheinman, MM, Aliot, EM. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular ArrhythmiasExecutive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines . Circulation. vol. 108. 2003. pp. 1871-1909.
Klein, GJ, Gulamhusien, SS. Intermittent preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol. vol. 52. 1983. pp. 292-6.
Campbell, RWF, Smith, R, Gallagher, JJ. Atrial fibrillation in the preexcitation syndrome. Am J Cardiol. vol. 40. 1977. pp. 514-20.
Auricchio, A, Klein, H, Trappe, HJ. Lack of prognostic value of syncope in patients with Wolff-Parkinson-White syndrome. J Am Coll Cardiol. vol. 17. 1991. pp. 152-8.
Wellens, HJ, Bar, FW, Gorgels, AP. Use of ajmaline in patients with the Wolff-Parkinson-White syndrome to disclose short refractory period of the accessory pathway. Am J Cardiol. vol. 45. 1980. pp. 130-33.
Brembilla-Perrot, B, Ghawi, R. Electrophysiological characteristics of asymptomatic Wolff-Parkinson-White syndrome. Eur Heart J. vol. 14. 1993. pp. 511-15.
Leitch, JW, Klein, GJ, Yee, R, Murdock, C. Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern. Circulation. vol. 82. 1990. pp. 1718-23.
Risk Factors For Developing Wpw
Risk factors for developing WPW include:
- Having a family member with pre-excitation or WPW: This is because mutations in certain genes can cause WPW.
- Congenital heart defect: Some people who are born with a specific heart defect known as “Ebstein’s anomaly” can develop WPW. This can occur if their mother was taking certain medications while she was pregnant.
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