One of the most common causes of rapid heartbeats is Wolff-Parkinson-White (WPW) syndrome. It is a rare congenital heart defect, which means it is present at birth, and it can go unnoticed into adulthood.

What is Wolff-Parkinson-White syndrome?

Wolff-Parkinson-White syndrome is a type of abnormal heartbeat that affects adults and children — one to three of every 1,000 people worldwide.

WPW syndrome occurs due to the presence at birth of an extra pathway in the heart that allows additional electrical signals to pass from the upper and lower heart chambers. This can result in a rapid heart rate of more than 100 beats per minute (this is known as tachycardia). WPW syndrome can also trigger a cardiac arrest.

What is the cause of Wolff-Parkinson-White syndrome?

In most cases, the cause of WPW syndrome is not known, but doctors have identified mutations in a gene that can be responsible. A small number of people may be at risk from inheriting this gene from a parent — this is called inherited or familial WPW syndrome.

Wolff-Parkinson-White Syndrome Symptoms

When someone has WPW syndrome, rapid heartbeat (tachycardia) can begin without warning and last for a few seconds or several hours. These episodes can occur during rest or exercise. For some people, there are many years between episodes of tachycardia.

The symptoms of WPW syndrome depend on the underlying heart rhythm disorder and the speed of the heartbeat. For instance, one of the more common irregular heartbeats seen in patients with WPW syndrome is called paroxysmal supraventricular tachycardia — a regular but rapid heartbeat that starts and stops abruptly. Conversely, the heartbeat may be rapid and erratic, which is a condition called atrial fibrillation. In a small subset of patients, atrial fibrillation may cause the ventricles to beat at a very rapid rate, which can trigger ventricular fibrillation.

WPW syndrome symptoms may start and stop suddenly, and they can occur at any age. (Symptoms in infants, listed in the next section, may differ from other age groups.)

Typical symptoms include:

• Chest pain
• Difficulty breathing
• Anxiety
• Fatigue
• Shortness of breath
• A pounding in the chest
• Dizziness
• Passing out

Wolff-Parkinson-White Syndrome Symptoms in Infants

The symptoms of WPW syndrome differ slightly for infants. Symptoms may include:

• Poor eating
• Restlessness
• Irritability
• Skin, lips and nails with a blue or grayish hue
• Rapid breathing

If you see these symptoms in your newborn or infant, talk to your child’s pediatrician.

Wolff-Parkinson-White Syndrome Diagnosis

If a person has symptoms of tachycardia that come and go, their doctor will do a test called an electrocardiogram (ECG), which measures the electrical activity in the heart and the heart rate. An ECG is the most important test to diagnose WPW syndrome. Other tests include:

• Receiving an ECG while walking on a treadmill
• Wearing a Holter monitor, a type of recorder that takes an ECG over 24 hours
• Wearing an event recorder that samples heart rate over several days
• Electrophysiologic testing — a hospital procedure during which catheters are threaded into the heart through a vein in the thigh

Wolff-Parkinson-White Syndrome Treatment

For patients with WPW syndrome who have a documented tachycardia, treatment is recommended. The first approach to treatment is catheter ablation, a minimally invasive procedure that has a high rate of cure (greater than 96%) and a very small risk of complications (less than 0.5%).

For patients who have evidence of WPW syndrome on their ECG while in normal heartbeat rhythm and who do not have symptoms, there are several treatment approaches. One approach is clinical follow-up and a stress test to determine if the WPW syndrome is potentially dangerous. Another approach is to perform an electrophysiology study to determine if the WPW syndrome is dangerous or can cause a tachycardia — if this is the case, catheter ablation can be performed at the same time.

Medications are typically not used to manage WPW syndrome, but they may be used when electrophysiology testing and catheter ablation are not options.  

Complications from Wolff-Parkinson-White Syndrome

WPW syndrome is not typically dangerous. Sudden death from ventricular fibrillation among people with WPW syndrome is extremely rare, occurring in less than .5% of cases.

Living with Wolff-Parkinson-White Syndrome

There is no way to prevent WPW syndrome, but complications from the condition can be prevented by learning about the disease and working closely with an electrophysiologist.

When to Seek Medical Assistance

 Talk to a doctor if palpitations occur or if a 12-lead ECG shows evidence of WPW syndrome. If WPW syndrome is diagnosed with continued heart palpitations, contact a cardiologist and/or electrophysiologist to help with evaluation and treatment.

If someone with WPW syndrome loses consciousness, please contact emergency medical services.

Also obtain emergency medical services for the following symptoms:

• Passing out
• An abnormal heartbeat that does not go back to normal within a few minutes
• Chest pain for longer than 15 minutes
• Chest of any duration pain along with pain in the jaw, back or arms
• Chest pain of any duration along with sweating, shortness of breath, nausea or vomiting