When To Seek Medical Advice
See a GP if you keep getting a fast or noticeable heartbeat . It’s important to get it checked out in case it could be something serious.
Dial 999 for an ambulance if:
- your heartbeat doesn’t go back to normal in a few minutes
- you have chest pain that lasts more than 15 minutes you may also have pain in your arms, back or jaw
- you have chest pain and other symptoms like feeling sick, being sick , shortness of breath or sweating
- someone passes out and doesn’t regain consciousness
If you’ve been diagnosed with WPW syndrome and you experience an episode, first try the techniques you’ve been taught or take any medication you’ve been given.
Dial 999 or go to your nearest accident and emergency department if these measures don’t stop the episode within a few minutes, or if someone you know has WPW syndrome and collapses or faints.
Orthodromic Tachycardia With Concealed Accessory Pathway
Some APs are unable to conduct in an antegrade fashion. These are called concealed APs, because “manifest” preexcitation is a delta wave that is visible on a surface 12-lead ECG. They account for about 30% of all SVTs induced on EPS.
Although no evidence of the pathway is present during sinus rhythm , orthodromic tachycardias can occur. Orthodromic tachycardia may also occur when there are two or more accessory connections, and in that case, the retrograde conduction may occur through the AV node, through one of the accessory connections, or through both.
This type of SVT may be difficult to distinguish from the usual AV nodal reentrant tachycardia on a standard surface ECG. In adults, if the heart rate is higher than 200 bpm or a retrograde P wave is visible in the ST segment , a concealed AP-mediated orthodromic reentrant tachycardia may be the diagnosis. However, this determination is most accurately made with electrophysiologic studies , or if SVT terminates with a single PVC. Other differentiating factors include the following :
Cleveland Clinic Heart Vascular & Thoracic Institute Cardiologists And Surgeons
Choosing a doctor to treat your abnormal heart rhythm depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with Arrhythmias:
- Section of Electrophysiology and Pacing: cardiology evaluation for medical management or electrophysiology procedures or devices – Call Cardiology Appointments at toll-free 800.223.2273, extension 4-6697 or request an appointment online.
- Department of Thoracic and Cardiovascular Surgery: surgery evaluation for surgical treatment for atrial fibrillation, epicardial lead placement, and in some cases if necessary, lead and device implantation and removal. For more information, please contact us.
- You may also use our MyConsult second opinion consultation using the Internet.
The Heart, Vascular & Thoracic Institute has specialized centers to treat certain populations of patients:
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Treatment Of Wpw Syndrome
Maneuvers and drugs to convert heart rhythm
Destruction of the extra conduction pathway by catheter ablation Destroying abnormal tissue Abnormal heart rhythms are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are… read more is successful in more than 95% of people. The risk of death during the procedure is less than 1 in 1,000. Ablation is particularly useful for young people who might otherwise have to take antiarrhythmic drugs for a lifetime.
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.
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Wolff Parkinson White Syndrome Treatment
In many cases, episodes of abnormal heart activity associated with Wolff Parkinson White syndrome are harmless, dont last long and settle down on their own without treatment.
You may therefore not need any treatment if your symptoms are mild or occur very occasionally, although you should still have regular check-ups so your heart can be monitored.
If your cardiologist recommends treatment, there are a number of options available. You can have treatment to either stop episodes when they occur, or prevent them occurring in the future.
Preventing An Episode That Has Started
Your doctor can advise on ways to interrupt the abnormal electrical signals and slow down the fast heartbeats. They include actions as simple as coughing in a particular way, or applying an ice pack to your face. Only do these if your doctor recommends them. Your doctor might also recommend medication to treat an episode.
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How Is Wpw Syndrome Diagnosed
People experiencing a fluttering or racing heartbeat usually tell their doctors. The same applies to those experiencing chest pain of difficulty breathing. However, if you dont have symptoms, the condition may go unnoticed for years.
If you have a racing heartbeat, your doctor will likely perform a physical exam and conduct tests that measure your heart rate over time to check for tachycardia and diagnose WPW syndrome. These heart tests may include:
Atrial Fibrillation And Wolff
Atrial fibrillation may be particularly dangerous for people with Wolff-Parkinson-White syndrome. The extra pathway can conduct the rapid impulses to the ventricles at a much faster rate than the normal pathway can. The result is an extremely fast ventricular rate that may be life threatening. Not only is the heart very inefficient when it beats so rapidly, but this extremely fast heart rate may also progress to ventricular fibrillation Ventricular Fibrillation Ventricular fibrillation is a potentially fatal, uncoordinated series of very rapid, ineffective contractions of the ventricles caused by many chaotic electrical… read more , which is fatal unless treated immediately.
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Symptoms Of Wpw Syndrome
Typically, when teenagers or people in their early 20s first experience an arrhythmia due to this syndrome, it is an episode of palpitations Palpitations Palpitations are the awareness of heartbeats. The sensation may feel like pounding, fluttering, racing, or skipping beats. Other symptomsfor example, chest discomfort or shortness of breathmay… read more that begins suddenly, often during exercise. The episode may last for only a few seconds or may persist for several hours. For most people, the very fast heart rate is uncomfortable and distressing. A few people faint.
In older people, episodes of paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome tend to cause more symptoms, such as fainting, shortness of breath, and chest pain.
What Are The Symptoms
Symptoms of Wolff-Parkinson-White Syndrome include the sense of feeling the heart beat rapidly , light-headedness, fainting, and dizziness.
Symptoms may start during the teen or young adult years.
How often a person has an episode of rapid heart rate varies. A person may have episodes of rapid heart rate once or twice a week, have rare episodes, or never have symptoms.
Episodes of WPW can trigger a life-threatening heart rhythm called ventricular fibrillation, although this is extremely rare. Your doctor may recommend that you wear a medical bracelet to alert medical professionals of your condition if you are at risk for ventricular fibrillation.
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What Is Pike Syndrome
Reluctant and fearful behavior that is based on assumptions that are no longer true has since become known as The Pike Syndrome. Most of us are not much different from the pike. We let self-limiting beliefs, past failures, or perceived shortcomings hold us back from new efforts. When that prospect turned you down.
How Is Wpw Diagnosed
WPW can only be diagnosed by reviewing an ECG . A holter or ambulatory monitor and exercise testing are also helpful in evaluating patients known to have WPW.
In the past, patients with WPW but without symptoms had been observed by a cardiologist for many years. Recently, new guidelines have been published for this group of patients. Your cardiologist may order a holter monitor or stress test to look for a persistent patter of WPW. If the WPW pattern persists, invasive electrophysiology testing is now recommended.
Your doctor will also ask you several questions:
- Do you have symptoms?
- Do you have a history of atrial fibrillation?
- Do you have a history of fainting?
- Do you have a history of sudden cardiac death or does anyone in your family?
- Are you a competitive athlete?
The results of your diagnostic tests and the answers to these questions will help guide your therapy.
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How Is It Treated And Managed
Catheter ablation is the most common treatment for people who have WPW syndrome and symptoms of an arrhythmia. This procedure can cure WPW syndrome in most people. If this treatment works for you, you can go back to your normal activities.
You may need one of more of the following treatments for an irregular heartbeat:
- Medicines that can control or prevent a fast heartbeat
- Cardioversion, which uses an electrical shock to your heart to restore its rhythm
If you have no symptoms of arrhythmias, you may not need any treatment. You may need regular checkups to check for a rapid or irregular heartbeat. Tell your doctor right away if you have any symptoms.
What Can I Do To Manage My Wpw
- Do not smoke. Smoking narrows blood vessels in your heart. Narrow blood vessels make your heart work harder. Smoking can also damage your heart. Ask your healthcare provider for information if you currently smoke and need help quitting.
- Carry medical alert identification. Wear jewelry or carry a card that says you have WPW. Ask your healthcare provider where to get these items.
- Exercise as directed. Exercise can cause WPW episodes. Ask your healthcare provider how much exercise you need each day and which exercises are safe for you. Ask if you can play sports.
- Limit caffeine. Caffeine can make your heartbeat faster.
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What Are Possible Complications Of Wolff
WPW usually is not a major problem for most people. You can manage or correct the condition with treatment. Worrisome symptoms include fainting with very rapid heart rates. There is a very small risk of cardiac arrest if the heart rate becomes extremely rapid. This may be seen in people who also have atrial fibrillation .
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Pearls And Other Issues
Patients with atrial fibrillation and rapid ventricular response are often treated with amiodarone or procainamide. Procainamide and cardioversion are accepted treatments for conversion of tachycardia associated with Wolff Parkinson White syndrome . In acute AF associated with WPW syndrome, the use of IV amiodarone may potentially lead to ventricular fibrillation in some reports and thus should be avoided.
AV node blockers should be avoided in atrial fibrillation and atrial flutter with Wolff Parkinson White syndrome . In particular, avoid adenosine, diltiazem, verapamil, and other calcium channel blockers and beta-blockers. They can exacerbate the syndrome by blocking the heart’s normal electrical pathway and facilitating antegrade conduction via the accessory pathway.
An acutely presenting wide complex tachycardia should be assumed to be ventricular tachycardia if doubt remains about the etiology.
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.
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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
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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Wolff Parkinson White Syndrome Diagnosis
If your doctor thinks you might have Wolff Parkinson White syndrome after assessing your symptoms, theyll probably recommend having an electrocardiogram and will refer you to a cardiologist .
An ECG is a test that records your hearts rhythm and electrical activity. Small discs called electrodes are stuck onto your arms, legs and chest and connected by wires to an ECG machine. The machine records the tiny electrical signals produced by your heart each time it beats.
If you have Wolff Parkinson White syndrome, the ECG will record an unusual pattern that isnt usually present in people who dont have the condition.
To confirm the diagnosis, you may be asked to wear a small portable ECG recorder so your heart rhythm can be recorded during an episode. A Holter monitor records your heart activity for 24 hours. An event recorder monitors heart activity when you experience symptoms of a fast heart rate. The recorder will trace your heart rate continuously over a few days, or when you switch it on at the start of an episode.
Electrophysiological testing. Thin, flexible tubes tipped with electrodes are threaded through your blood vessels to various spots in your heart. The electrodes can precisely map the spread of electrical impulses during each heartbeat and identify an extra electrical pathway.
Wolff Parkinson White Syndrome Complications
For many people, WPW syndrome doesnt cause significant problems. But complications can occur, and its not always possible to know your risk of serious heart-related events. If the disorder is untreated, and particularly if you have other heart conditions, you may experience:
- Fainting spells
- Rarely, sudden death
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Causes & Risk Factors Of Wolff
Wolff-Parkinson-White syndrome is a condition in which individuals are born with an accessory pathway in their hearts, which can cause many complications. There have been occasional cases of Wolff-Parkinson-White syndrome leading to cardiac arrest, and it can be fatal. Wolff-Parkinson-White syndrome can be somewhat unpredictable, as some who are born with it never experience symptoms while others can become symptomatic at any age. While the true cause of Wolff-Parkinson-White syndrome remains unknown in many cases, there is evidence to suggest, in addition to the extra electrical pathway in heart, there are a few other factors for the condition.