Wolff-Parkinson-White (WPW) Syndrome and Tachycardia: Understanding the Condition, Triggers, and Treatment

By SWA

Overview

Wolff-Parkinson-White (WPW) syndrome is a rare but significant cardiac condition characterized by the presence of an extra electrical conduction pathway in the heart. This congenital anomaly predisposes individuals to episodes of tachycardia—abnormally fast heart rhythms—that can be alarming and potentially dangerous. Although many people with WPW may remain asymptomatic for years, others may experience frequent palpitations, dizziness, or even syncope (fainting).

In this article, we delve into the pathophysiology of WPW syndrome, the nature of tachycardia associated with it, diagnostic procedures, treatment options, and critically, the list of medications and substances that must be avoided to prevent life-threatening arrhythmias. A Stress cardiomyopathy. The same symptoms as heart failure.

Pathophysiology of WPW Syndrome

The hallmark of WPW syndrome is the presence of an accessory conduction pathway—often referred to as the Bundle of Kent—which connects the atria directly to the ventricles, bypassing the normal delay of the atrioventricular (AV) node. This abnormal connection can facilitate a phenomenon known as re-entrant tachycardia, where electrical impulses loop back through the heart’s conduction system, causing the heart to beat abnormally fast.

This alternate route can lead to various forms of supraventricular tachycardia (SVT), including:

  • Atrioventricular Reentrant Tachycardia (AVRT) – the most common type in WPW.

  • Atrial fibrillation with rapid ventricular response – a potentially life-threatening complication if the accessory pathway conducts impulses very rapidly.

Symptoms of WPW Syndrome

Symptoms may occur sporadically and can range from mild to severe. Common symptoms include:

  • Sudden, rapid heartbeat (palpitations)

  • Dizziness or lightheadedness

  • Chest discomfort or chest pulsations

  • Shortness of breath

  • Fainting (syncope)

  • Fatigue (especially after episodes)

In rare cases, WPW syndrome can lead to sudden cardiac arrest, especially if atrial fibrillation leads to extremely rapid conduction through the accessory pathway.

Diagnosis

WPW syndrome is most often diagnosed through an electrocardiogram (ECG or EKG). Classic findings include:

  • A short PR interval (<120 ms)

  • A delta wave (a slurred upstroke at the beginning of the QRS complex)

  • Widened QRS complex

If symptoms are intermittent, a Holter monitor or event recorder may be used to capture episodes. Electrophysiological studies (EPS) are often performed to precisely map the accessory pathway.

Treatment Options

1. Catheter Ablation

The gold standard and often curative treatment for WPW syndrome is radiofrequency catheter ablation. This procedure targets and destroys the accessory pathway, restoring normal conduction and eliminating the potential for re-entrant tachycardias.

  • Success Rate: Over 95% with low complication rates.

  • Recurrence: Rare after successful ablation.

2. Medications

While catheter ablation is preferred, medications may be used in the interim or in individuals who are not candidates for ablation.

However, caution is crucial, as some medications that are otherwise effective for heart rate control can worsen arrhythmias in WPW.

Medications and Substances to Avoid in WPW

AV Node Blockers:

These drugs slow conduction through the AV node but do not affect the accessory pathway. In WPW, this can paradoxically enhance conduction through the accessory pathway, increasing the risk of ventricular fibrillation, a potentially fatal rhythm.

Avoid the following:

  • Adenosine – Can unmask accessory pathway conduction and provoke ventricular arrhythmias.

  • Calcium Channel Blockers (e.g., Verapamil, Diltiazem) – Similar mechanism to adenosine; can dangerously slow AV node conduction.

  • Beta-Blockers – Reduce AV nodal conduction; risk of enhancing accessory pathway dominance.

  • Digoxin – Shortens the refractory period of the accessory pathway, increasing the likelihood of rapid conduction during atrial fibrillation.

Problematic Anesthetic Agents and Other Substances

Certain anesthetics and commonly used medications can affect heart rate and AV conduction, posing risks in WPW patients, especially during surgery or procedural sedation.

Anesthetic and Perioperative Drugs to Avoid:

  • Atropine & Glycopyrrolate – Anticholinergics that increase heart rate and may precipitate tachycardia.

  • Ketamine – Elevates heart rate and blood pressure; contraindicated in WPW.

  • Neostigmine – Can facilitate conduction through the accessory pathway.

  • Desflurane – Potential to alter conduction dynamics; use with caution.

Safer Anesthetic Alternatives:

  • Isoflurane and Sevoflurane – Minimal impact on AV node conduction and preserve hemodynamic stability.

  • Fentanyl – Offers stable hemodynamics and is generally safe for WPW patients.

Other Substances That May Trigger Arrhythmias

  • Stimulants (e.g., Amphetamines, Cocaine): Dramatically increase heart rate and arrhythmic risk.

  • Pseudoephedrine: Found in cold medications; can increase heart rate.

  • Caffeine: May contribute to palpitations.

  • Alcohol & Tobacco: Can exacerbate arrhythmia risk through various mechanisms.

Lifestyle and Safety Recommendations

  • Medical Alert: Individuals with WPW should wear a medical alert bracelet or have clear documentation of their condition.

  • Communication: Inform all healthcare providers (including dentists and pharmacists) about WPW diagnosis before any procedures or medications are administered.

  • Avoidance of Triggers: Minimize or eliminate stimulant use, alcohol, tobacco, and high-caffeine beverages.

  • Exercise: While moderate exercise is often safe, high-intensity sports should be approached with caution and under medical guidance.

Prognosis

For most individuals, especially those who undergo successful catheter ablation, the prognosis is excellent. Many are able to return to normal lives without restrictions. Even in cases where ablation is not performed, careful management and lifestyle modifications can significantly reduce the risk of complications.

Conclusion

Wolff-Parkinson-White syndrome, while potentially serious, is a treatable and often curable condition. With proper diagnosis, patient education, and avoidance of contraindicated medications and substances, individuals with WPW can live healthy, active lives.

It’s essential for both patients and healthcare providers to remain vigilant about the unique considerations of this syndrome, particularly when it comes to drug interactions and anesthesia management. A tailored, informed approach is key to ensuring safety and optimal outcomes.

Reference: 

Booster COVID-19 vaccine comirnaty ignite supraventricular tachycardia in Wolff Parkinson White Syndrome

Pfizer-BioNTech COVID-19 Vaccine which marketed as Comirnaty is the first approval of COVID-19 vaccine in year 2021 by National Pharmaceutical Regulatory Agency (NPRA) Malaysia and booster dose of vaccine is advocated to increase the immunity protection from severe disease of COVID-19 variant. https://pmc.ncbi.nlm.nih.gov/articles/PMC9771588/

Wolff Parkinson White Syndrome:
https://www.thecardiologyadvisor.com/ddi/wolff-parkinson-white-syndrome/

Anesthetic management in a patient with Wolff-Parkinson-White syndrome for laparoscopic cholecystectomy https://pmc.ncbi.nlm.nih.gov/articles/PMC4173513/

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742

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