Wolff-Parkinson-White syndrome

Wolff-Parkinson-White pattern, or WPW, is a type of heart arrhythmia caused by an accessory pathway, or an extra electrical conduction pathway, connecting the atria and ventricles, or the upper and lower chambers of the heart.

Normally, an electrical signal starts at the sinoatrial node, or SA node, in the right atrium. It then propagates out through both atria, including bachmann’s bundle in the left atrium, and contracts both atria. Then, it’s delayed just a little bit as it goes through the atrioventricular node, or AV node, before it passes through the Bundle of His and to the Purkinje fibers of the left and right ventricles, causing them to contract as well.

On an electrocardiogram, the P-wave corresponds to atrial contraction, the PR interval corresponds to the slight delay through the AV node, and the QRS complex corresponds to ventricular contraction.

Now, in a normal electrical conduction system, the AV node is the only place where the signal can get through to the ventricles from the atria. It’s kind of like there’s a gatekeeper that has to stop the signal and make sure everything’s good before letting it pass, so there’s always a slight delay here. People with WPW essentially have a secret, backdoor entrance. Because this entrance is secret, it doesn’t have a gatekeeper; therefore, there’s no delay as the signal moves through it. This secret backdoor entrance is a tiny bundle of cardiac tissue that conducts electrical signals really well, called the Bundle of Kent. Using the Bundle of Kent means the ventricles start to contract a little bit early, which is called pre-excitation. If the Bundle is on the left side of the heart, it’s called “type A pre-excitation.” If it’s on the right side, it’s called “type B pre-excitation.” Type A, on the left side, is a lot more common.