What are the symptoms of Wolff-Parkinson-White (WPW) syndrome?

Symptoms of Wolff-Parkinson-White Syndrome

The most common symptoms of Wolff-Parkinson-White (WPW) syndrome include palpitations, dizziness, syncope, chest pain, and shortness of breath, with approximately 64% of patients experiencing symptoms at initial presentation and an additional 20% developing symptoms during follow-up. 1

Common Presenting Symptoms

• Palpitations: The most frequent symptom, occurring in 22% of patients at presentation 1

• Chest pain: Reported in 5% of patients 1

• Syncope: Occurs in approximately 4% of patients 1

  • True syncope is infrequent with SVT, but complaints of light-headedness are common
  • Syncope in WPW patients should be taken seriously but is not necessarily associated with increased risk of sudden cardiac death 1

• "Shirt flapping" or "neck pounding": Patients may describe these unique sensations related to cannon a-waves (when the right atrium contracts against a closed tricuspid valve) 1

• Dyspnea: Particularly during tachycardia episodes 2

Symptom Characteristics by Age and Gender

• Age of symptom onset:

  • Adults: Mean age of 32±18 years for AVNRT vs. 23±14 years for AVRT 1
  • Pediatric patients: Mean ages of onset are 8 years for AVRT and 11 years for AVNRT 1

• Gender differences:

  • Women experience more symptoms when driving (77% felt fatigue, 50% had near-syncope symptoms, and 14% experienced syncope) 1
  • Women are more likely to have AVNRT than AVRT 1

Documented Arrhythmias

• Supraventricular tachycardia (SVT): Documented in 38% of patients 1
• Atrial fibrillation (AF): Occurs in 0.4% of patients 1
• Sudden cardiac death (SCD): Rare but serious complication, occurring in 0.2% of patients 1

Impact on Daily Life

• Driving impairment: 57% of patients with SVT experienced an episode while driving, with 24% considering it an obstacle to driving 1

• Quality of life impact: Varies according to:

  • Frequency of episodes
  • Duration of SVT episodes
  • Whether symptoms occur only with exercise or also at rest 1

Risk Factors for Sudden Cardiac Death

Patients with WPW at higher risk for sudden death include those with:

• Shortest pre-excited R-R interval less than 250 ms during AF 1
• History of symptomatic tachycardia 1
• Multiple accessory pathways 1
• Ebstein's anomaly 1

Clinical Pitfalls and Caveats

• Asymptomatic patients: Many individuals with WPW pattern on ECG remain asymptomatic throughout their lives 3

• Differential diagnosis challenges: Symptoms of WPW must be differentiated from:

  • Panic and anxiety disorders
  • Heightened awareness of sinus tachycardia
  • Postural orthostatic tachycardia syndrome 1

• Elderly patients: More prone to syncope or near-syncope with AVNRT than younger patients, despite generally slower tachycardia rates 1

• Sudden death risk: Although rare (0.15% to 0.39% over 3-10 years), sudden cardiac death can be the first manifestation of WPW in about half of cardiac arrest cases in these patients 1

• Exercise capacity: Some patients may experience reduced exercise capacity due to anomalous left ventricular depolarization, particularly with certain accessory pathway locations 4

Early recognition of these symptoms and prompt referral for evaluation is critical for appropriate management and prevention of potentially life-threatening arrhythmias in patients with WPW syndrome.