Wolff-Parkinson-White Syndrome

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What is Wolff-Parkinson-White syndrome?

Wolff-Parkinson-White (WPW) is when the heart has an extra electrical pathway, also called an accessory pathway. Because of this extra pathway, electrical signals in the heart avoid the normal electrical pathway. This can lead to life-threatening heart rhythm problems.

In WPW, children are usually born with the extra pathway. About 10% to 20% of infants with WPW also have congenital heart disease, in particular Ebstein’s anomaly.

How does a normal heartbeat happen?

The heart has 4 chambers (spaces that hold blood): 2 atria at the top and 2 ventricles at the bottom. A complex electrical system makes these chambers squeeze and relax, at the right time and in the right order, to pump blood.

A heartbeat starts in the right atrium when a group of cells (sinus node) sends an electrical signal. The signal travels through the atria, making their muscle walls squeeze. Then the signal moves into the area between the atria and ventricles. This area is the atrioventricular node (AV node).

The AV node slows the signal slightly and then passes it on to the ventricles, making them squeeze. After the ventricles squeeze, the heartbeat cycle is complete.
What is different in Wolff-Parkinson-White syndrome?
In WPW, electrical signals in the heart do not travel along the normal route because of the extra (accessory) pathway. This may lead to 2 kinds of heart rhythm problems:
- Supraventricular tachycardia (SVT). Tachycardia (pronounced tack-ih-CARD-ee-ah) means the heart is beating too fast. Children with SVT may need treatment with medicines, radiofrequency ablation or cryoablation. SVT is not usually life threatening.
- Atrial fibrillation leading to ventricular fibrillation. Fibrillation (pronounced fib-rill-AY-shun) means very fast, irregular twitching of a muscle. Atrial fibrillation is rare in children.
  - When it happens to someone without WPW, the normal route of electricity in the heart slows down signals from the atria to the ventricles. This limits how quickly the ventricles beat.
  - When it happens to someone with WPW, the extra pathway can send signals too fast from the atria to the ventricles. This can cause ventricular fibrillation, which is life threatening. This heart rhythm problem may need to be reset using a defibrillator.

Heart Center at Seattle Children's

Our pediatric cardiologists and cardiac surgeons have more advanced training and experience operating and performing procedures on babies, children and teens than at any other children's hospital in the Pacific Northwest.

Symptoms of Wolff-Parkinson-White Syndrome

Some children with WPW begin having symptoms shortly after birth or in early childhood. Other children with WPW may never have symptoms or may develop them later in childhood or even as adults.

WPW syndrome can cause these problems with your child’s heartbeat:

Their heart beats too quickly (tachycardia, pronounced tack-ih-CARD-ee-ah).
Their heartbeat is irregular – the speed and pattern change.
They have palpitations.

You and your child may or may not notice any of these problems. Sometimes, families have no idea their child has WPW syndrome until a doctor notices signs during a regular check-up or the child has an electrocardiogram (ECG) for some other reason.

Because the heartbeat affects blood flow, arrhythmia sometimes causes these symptoms:

Feeling faint, weak, lightheaded or dizzy
Being short of breath
Having chest pain
Sweating
Fainting (syncope)

Rarely, children with WPW experience sudden cardiac arrest (the heart stops beating). In rare cases, this is the first symptom the child has.

Diagnosing Wolff-Parkinson-White Syndrome

To diagnose this condition, your child’s doctor will examine your child, check their heartbeat and use a stethoscope to listen to their heart. The doctor will ask for details about any symptoms your child has, their health history and your family health history.

To learn about the electrical activity in your child’s heart, the doctor will use an ECG. If an abnormal heartbeat does not happen during this test, your child may need to wear a portable rhythm-monitoring device at home.

A Holter monitor can record your child’s heart’s activity for 24 hours.
An event recorder can be turned on by your child when they feel a problem with their heart rhythm.

To get more information about how your child’s heart looks and works, your child may need other tests, like an exercise test and electrophysiology studies to help locate the extra pathway in your child’s heart.

Your child may also need chest X-rays, MRI (magnetic resonance imaging) of the heart, angiography or echocardiography.

Treating Wolff-Parkinson-White Syndrome

Children with WPW do not always need treatment. Often, an irregular heartbeat does not cause any problems. But sometimes it keeps the heart from pumping the right amount of blood to the brain or other organs. This can be dangerous. So, it is important to have your child’s heart checked by a doctor who can offer treatment if your child needs it.

Medicines

Your child may need treatment if they have symptoms or they have a fast heartbeat that happens often or lasts for a while. Doctors treat WPW first with medicines that control the heart rate.

Ablation

If medicine does not work well enough, doctors may use ablation. They may also use ablation to get rid of an abnormal electrical pathway if it poses a dangerous risk to your child.

Ablation is a procedure that uses a thin plastic tube (catheter) to destroy the tissue that causes the rapid heartbeat. Traditionally, doctors did this with a catheter that used radiofrequency energy to burn (cauterize) the abnormal tissue.

Now, doctors sometimes use cryoablation. This method destroys the tissue by freezing it. This newer technique may be safer. It also seems that the heart tissue is able to recover better after cryoablation. Talk with your heart doctor about which method is best for your child.

Read more about the treatment options we offer through our Arrhythmia Program and in our Cardiac Catheterization Lab.

Wolff-Parkinson-White Syndrome at Seattle Children’s

The experts you need are here
- Seattle Children’s team of 40+ pediatric cardiologists diagnoses and treats WPW in children of all ages, from newborns to adolescents.
- Our Arrhythmia Program includes 3 full-time pediatric electrophysiologists, more than anywhere else in the region. After their training in pediatric cardiology, they have further subspecialty training in dealing with cardiac arrhythmias. The Arrhythmia Program is also supported by a team of specialty technicians and nurses who know how to deal with these conditions.
- We offer a full range of diagnostic procedures and treatments. Along with using heart medicines, we have deep experience with radiofrequency ablation and cryoablation procedures in children who need them to correct an abnormal heart rhythm.
Among the nation’s top programs
- See our statistics and outcomes.
Care from before birth through young adulthood
- If your developing baby is diagnosed with supraventricular tachycardia before birth, our Fetal Care and Treatment Center team works closely with you and your family to plan and prepare for the care your baby will need.
- Your child’s treatment plan is custom-made for them. Some children with WPW do not need treatment, and others do. We closely watch your child’s needs to make sure they get the care that is right for them at every age.
- If your child was born with WPW, we have a special Adult Congenital Heart Disease Program to meet your child’s long-term healthcare needs. This program, shared with the University of Washington, transitions your child to adult care when they are ready.
Support for your whole family
- We are committed to your child’s overall health and well-being and to helping your child live a full and active life.
- Whatever types of care your child needs, we will help your family through this experience. We will discuss your child’s condition and treatment options in ways you understand and involve you in every decision.
- Our nurses are experienced at supporting families with WPW. They help manage your child’s care and teach you and your child about this condition.
- Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age.
- Seattle Children’s has many resources, from financial to spiritual, to support your child and your family and make the journey as smooth as possible. We regularly see families who travel from other states and countries to come to our Arrhythmia Program.
- Read more about the supportive care we offer.
Advancing pediatric care
- Doctors at Seattle Children’s are working to advance treatment for WPW and enhance the quality of life for children with this condition.
- We were the first institution in the region to routinely offer cryoablation for children, greatly increasing the safety of ablation for arrhythmia.
- Seattle Children’s is one of the few institutions in the region to offer “zero fluoro” or “minimal fluoro” ablation. This means we use techniques – many that we developed – to expose your child to little or no X-ray radiation. Most places use fluoroscopy during ablation.
- Stephen Seslar has been part of creating databases to track ablation procedures and outcomes. He has used the data to help identify risk factors for sudden death in children with WPW.
- Jack Salerno has worked with organizations, like the Nick of Time Foundation, to help identify young people who might have WPW or other arrhythmia conditions before they develop a problem.
- Terrence Chun has a special interest in improving methods to detect conditions like WPW and improving the safety and accuracy of ablation procedures to cure this condition.