What is it?

Wolff-Parkinson-White (WPW) is a disorder of the heart’s electrical conduction system. Normally, the electrical signal follows a very specific pathway through the heart starting at the sinoatrial (SA) node moving through the top two chambers of the heart (atria) to the atrioventricular (AV) node located between the atria and the bottom two chambers of the heart (ventricles). From there, it travels down through the ventricles.

The electrical current causes the atria and ventricles of the heart to beat and push blood through the body. In WPW, the structure of the heart muscle is typically normal, however there are abnormal extra or accessory electrical pathways, outside the AV node, between the atria and ventricles. This increases the risk of abnormal heart movements and deadly heartbeats called arrhythmias.

WPW about 1-4.5 per 1,000 people, and has a higher risk in family members, as it can be genetically inherited. Exercise is a trigger for the abnormal electrical pathway, and WPW is one of the most commonly identified conditions for sudden cardiac death in athletes.

Symptoms/Risks

Symptoms are a result of an abnormal heartbeat and are usually triggered by exercise. Unfortunately, there are some individuals who do not feel symptoms or whose first symptom is death.

Typical symptoms are:

• Abnormal heart beats (palpitations), felts as racing heart or skipped beats

• Dizziness or lightheadedness

• Feeling like you might pass out (presyncope) or actually passing out (syncope)

• Shortness of breath

• Sudden death

Sports Medicine Evaluation & Treatment

WPW is diagnosed by looking at the heart’s electrical activity with an electrocardiogram (ECG or EKG). Sports medicine physicians have extra training in reading EKGs, especially what is normal or abnormal for an athlete. If an athlete has symptoms, a family history of WPW or sudden cardiac death, then an ECG should be performed.

If WPW is diagnosed, the patient will need to see a cardiologist to identify the type and speed of the abnormal electrical pathway. If treatment is needed, the cardiologist will consider a procedure called a catheter ablation. This gets rid of the extra electrical pathway, which can cure the disorder.

Injury Prevention

During sports pre-participation physical exams, the sports medicine physician will ask specifically about symptoms for WPW and other heart disorders and listen to your heart. If necessary, they will perform or recommend an ECG, and withhold exercise until safe.

Return to Play

Return to play after diagnosis of WPW depends on the type of the extra electrical pathway, as well as activity level of the athlete. If the athlete has a low-risk pathway and participates in a low-risk sport, then a discussion of symptom monitoring, risks and close follow-up can be decided. If the athlete has symptoms, has a high-risk pathway, or participates in high-risk sports, then the athlete needs to see a cardiologist to consider an ablation. After the procedure, if there are no symptoms and there is a normal ECG, an athlete can consider returning to play.

AMSSM Member Authors
Geoffrey Dreher, DO

References
Harmon, K., Zigman, M. and Drezner, J. (2015). The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: A systematic review/meta-analysis. Journal of Electrocardiology, 48(3), pp.329-338.
Rao, A., Salerno, J., Asif, I. and Drezner, J. (2013). Evaluation and Management of Wolff-Parkinson-White in Athletes. Sports Health: A Multidisciplinary Approach, 6(4), pp.326-332.