Wolff-Parkinson-White (WPW) Syndrome Treatment in Delhi, India

Wolff-Parkinson-White syndrome is an extra signalling pathway between the upper and lower chambers of the heart that causes a rapid heartbeat (tachycardia). It is also known as preexcitation syndrome. This condition is a congenital heart defect, which means that it has been present since birth. However, the syndrome is relatively rare.

WPW syndrome is not life-threatening but poses a risk of a serious heart problem. Rarely, it may cause sudden cardiac death in children and young adults.

Symptoms of Wolff-Parkinson-White Syndrome

Symptoms of Wolff-Parkinson-White syndrome may include one or more of the following:

• Racing feeling in the chest.
• Shortness of breath (dyspnea) during fast heartbeats.
• Heart palpitations – a sudden pounding, fluttering.
• Dizziness – feeling lightheaded or faint.
• Anxiety
• Fatigue
• Rarely, cardiac arrest (sudden death).

Signs and symptoms seen in infants include:

• Pale or faded skin colour (pallor).
• Restlessness or irritability.
• Rapid breathing.
• Blue or grey discolouration of the skin, lips, and nails (cyanosis).
• Poor nutrition

Some people have WPW without any symptoms, and the condition is known as WPW pattern. This pattern is detected on routine ECG.

Diagnosis of Wolff-Parkinson-White Syndrome

Cardiac tests allow the detection of unusually rapid heartbeats and help assess conditions that may cause arrhythmias. The tests include:

• Electrocardiogram: This quick and painless test measures the heart's electrical activity. During an ECG, sensors are placed in different positions on the chest, arms and legs. It helps assess the signal patterns of the heart. This helps determine the type of tachycardia and what may be causing the rapid heart rate. Some of the latest personal devices, like smartwatches, also monitor electrocardiograms.
• Event monitoring: Event monitoring is advisable when long-term heart functioning readings need recording.
• Holter monitoring: Continuous monitoring of the heart rhythm for 24 hours can be done using this portable device. It can be used for several days if needed.
• Echocardiogram: This uses sound waves to form images of the heart in motion. It helps assess issues with the flow of blood, heart valves, and heart muscle. Echo will define cardiac anatomy to rule out structural defects and assess ventricular function.
• Chest X-ray: It helps evaluate the status of the lungs and heart.
• Cardiac magnetic resonance imaging (MRI): This test provides still or moving pictures of blood flow through the heart and helps determine the cause of ventricular tachycardia or ventricular fibrillation. MRI is needed in selective cases of arrhythmia. It provides information about the cardiac structure and function to look for causes of arrhythmia.
• Electrophysiological (EP) testing and mapping: Also called an EP study, helps confirm a tachycardia diagnosis or determine where the faulty signalling occurs in the heart. An EP study is mainly used to diagnose isolated arrhythmias.

Treatment for Wolff-Parkinson-White Syndrome

The treatment for Wolff-Parkinson-White (WPW) syndrome depends upon the severity and frequency of symptoms. Additionally, factors such as the type of heart rhythm problem (such as arrhythmia) causing the fast heart rate also contribute to deciding on a treatment plan. The treatment goals are to slow a fast heart rate when it occurs and prevent future episodes. Treatment options for a rapid heart rate include:

• Vagal manoeuvres: Vagal manoeuvres such as coughing, sitting down, and having a bowel movement all affect the vagal nerve, which lowers heart rate. During these positions, specific actions must be performed when a rapid heartbeat episode occurs.
• Cardioversion is a procedure that can help rectify irregular heartbeats. It is performed when medicines fail to regularize heart rhythm or the child is sick. This method uses electrical impulses to normalize heart rhythm.
• Medications: If vagal manoeuvres fail to control a rapidly beating heart, medicines can help improve the condition and restore heart rhythm. Intravenous medicines act faster and are the chosen route of drug administration.
• Catheter ablation: Radiofrequency waves are used to destroy the abnormal pathway (accessory pathway) after defining by electrophysiology study.

Lifestyle and Home Remedies

Doctors recommend following a heart-healthy lifestyle for patients with Wolff-Parkinson-White (WPW) syndrome or episodes of a fast heart rate. Take these steps:

• Avoid caffeine or other stimulants
• Don't smoke
• Limit or avoid alcohol
• Maintain a healthy weight
• Eat a healthy diet
• Get regular exercise
• Manage emotional stress

Complications of Wolff-Parkinson-White Syndrome

Some complications of Wolff Parkinson's White syndrome include the following:

• Tachyarrhythmia
• Dizziness or syncope
• Complications of drug therapy (e.g., arrhythmia)
• Palpitations
• Sudden cardiac death
• Complications associated with invasive procedures and surgery.
• Recurrence

Risk Factors of Wolff-Parkinson-White Syndrome

Risk factors that place a patient at higher risk for sudden cardiac death include:

• Male gender
• Septal location of the accessory pathway.
• History of atrial fibrillation or AVRT.
• Age less than 35 years.
• Multiple accessory pathways.
• Rapid anterograde conduction of the accessory pathway.

Prognosis of Wolff-Parkinson-White Syndrome

Once identified and treated, Wolff Parkinson's White syndrome has an excellent prognosis. Furthermore, it has the potential for a permanent cure with radiofrequency (RF) catheter ablation therapy. Asymptomatic patients with only preexcitation on ECG also have a very good prognosis. However, many develop symptomatic arrhythmias over time, which may be prevented with prophylactic EPS and RF catheter ablation.

People who have a history of a sudden heart attack in their family or symptoms of tachyarrhythmias or cardiac arrest have the worst prognosis. However, the prognosis is excellent if timely treatment is provided, including curative ablation.

Review

Reviewed by Dr. Munesh Tomar - Director, Paediatric (Ped) Cardiology, Cardiac Sciences, Cardiology.