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Wolff-Parkinson-White Syndrome Clinic

Pediatric Heart Care

Wolff-Parkinson-White Syndrome Clinic

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Dr. Nicholas Von Bergen, American Family Children's Hospital

Dr. Nicholas Von Bergen at UW Health's American Family Children's Hospital in Madison, Wisconsin, treats patients who have been dignosed with Wolff-Parkinson-White Syndrome or might be at risk for this syndrome.

The clinic is currently once a month on Tuesday, but special arrangements can be made if necessary. Phone consultation can also be arranged in special cases.

What is Wolff-Parkinson-White Syndrome?

Wolff-Parkinson-White Syndrome (WPW) is diagnosed when a patient has an abnormal finding on their electrocardiogram (ECG) and has a history of a fast heart rate. This abnormal ECG finding is called a delta wave, a finding not seen in the normal heart.

A normal ECG, and an ECG with a delta wave, as seen in patients with Wolff-Parkinson-White Syndrome
A normal ECG, and an ECG with a delta wave, as seen in patients with Wolff-Parkinson-White Syndrome.

To better understand WPW, we need to compare to the normal heart.

In the normal heart, the electricity of the heart begins in the atria, the top chambers of the heart. The electricity then passes through the atria and to the AV node. The AV node is a muscular bridge that allows the electricity to slowly pass from the atria to the ventricles. The electricity then completes its path by passing through the ventricles. Each time the electricity passes through the heart it causes the heart muscle to squeeze, resulting in a heartbeat. The electricity then begins again and the process repeats itself.

Wolff-Parkinson-White Syndrome

In patients with WPW there is a second muscular bridge, an accessory pathway, which allow electricity to pass between the atria and the ventricles much more quickly than the normal AV node. When the electricity reaches the ventricle more quickly than expected, this can be seen on an ECG as the delta wave.

If the electricity passes down the normal route through the AV node, it can occasionally return to the atria across this accessory pathway. The electricity could then pass back to the ventricle through the AV node causing a loop of current. If the loop continues, this can result in supraventricular tachycardia (SVT). SVT often presents as a sudden onset fast heart rate, often with rates faster than 220 beats per minute. This fast heart rate may stop on its own, may stop with vagal maneuvers (see below) or may require a physician to convert the rhythm back to normal.

Wolff-Parkinson-White Syndrome

Unfortunately, WPW may be associated with an increased risk of concerning cardiac events. Therefore, it is important to determine this risk after being diagnosed with WPW. To do this, a patient may undergo an exercise treadmill test or a 24 hour monitor. If the abnormal finding on the ECG, the delta wave, disappears at higher heart rates the patient is generally not at a high risk for concerning cardiac events.

Depending on the ECG findings and the patients symptoms there are multiple options for treatment. These should be discussed with your physician, and often include continued monitoring with or without medications, or an electrophysiology study with ablation. An electrophysiology study with ablation is an outpatient catheterization procedure with an excellent likelihood of a permanent cure.

During an episode of an elevated heart rate, vagal maneuvers may be attempted to return the heart rate back to normal. For a clear understanding of vagal maneuvers, please discuss with your physician.

Vagal maneuvers include:

  1. Increasing the pressure in your chest by bearing down (similar to a bowel movement). In infants, the infant's knees may pushed to the chest to cause them to strain.
  2. Increasing the blood flow to the head by placing yourself upside down. Some individuals will stand on their head. Infants can be held with their head downward, and adults may "sit" head-side down on a chair/couch with the feet up and head hanging below the level of the heart. This can be done at the same time as vagal maneuver No. 1.
  3. Placing cold ice water on the face for approximately 5 seconds. Using a wet washcloth can be helpful. The cold washcloth can be placed over the forehead and eyes for 5 seconds before removing and letting the face warm.

If these are not effective, or the SVT causes significant symptoms, individuals should seek care at an emergency room.

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What tests or procedures might be done during a visit to the clinic?

  • Exercise (treadmill) testing. An exercise treadmill test can be done to evaluate the hearts response to exercise. It may be done on a treadmill or an exercise bike. Red video icon Watch video
  • Holter monitoring. A holter monitor is a continuous electrocardiogram which can be worn for 1-2 days. It is generally placed at the clinic and mailed back after it is complete.
  • Echocardiogram. An echocardiogram is an ultrasound of the heart which evaluates its structure and the function. Red video icon Watch video
  • Electrocardiogram. An electrocardiogram, also known as an ECG, is a test that records the electrical activity of the heart. Red video icon Watch video

What is Electrophysiology Study with Ablation?

An electrophysiology (EP) study is a cardiac catheterization which evaluates the electrical system of the heart. It can help discover the cause of palpitations (a racing heart), abnormal heart rhythms or fainting, and it may also be used evaluate patients who have WPW.

An ablation is a procedure that treats the abnormal heart rhythm by burning or freezing the tissue causing the abnormal rhythm. An ablation can be done at the same time as an EP study if it is appropriate.

During these procedures, younger patients are generally placed under anesthesia so are not aware of the procedure. Older patients may be placed under general anesthesia or lighter sedation. A typical procedure may last 2-3 hours, but could last longer if the procedure is challenging or if there are multiple abnormal heart rhythms.

During the procedure, catheters (long flexible wires) are usually placed though the femoral veins near the crease between the leg and pelvic area. They are then passed to the heart and placed in the heart to map the heart’s electrical signals. These catheters can also pace the heart to cause the abnormal heart rhythms. At American Family Children's Hospital, unlike many centers, we eliminate the use of radiation in the majority of our procedures by using computerized 3-D mapping equipment in place of x-rays to move the catheters.

3-D Mapping

The procedure is both safe and effective, with approximately a 95% long-term success rate for most arrhythmias.

At the American Family Children's Hospital we use cryotherapy (cold therapy) for arrhythmia that are at higher risk of complications, such as that which could require a pacemaker. Cryotherapy has the advantage of being reversible with short applications. Because of this, and a focus on safety, the risk with the procedure is extremely low. For details regarding the procedure please discuss with your physician or contact our clinic for information.

Dr. Von Bergen discusses Electrophysiology Study with Ablation

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Why choose Dr. Von Bergen and UW Health to treat WPW?

At the American Family Children's Hospital we use used advanced techniques to make the procedure more safe and more effective, and should be considered if you are deciding on an ablation. First, we use cryotherapy (cold therapy) for arrhythmia that are at higher risk of complications, such as that which could require a pacemaker. Cryotherapy has the advantage of being reversible with short applications. Because of this, and a focus on safety, the risk of complications with cryotherapy is extremely low.

We also use 3-D mapping to eliminate the use of radiation from the majority of ablation procedures. Though many centers utilize 3-D mapping to lower the patients exposure to radiation, most continue to use radiation for catheter guidance for the majority of their procedures.

For details regarding the procedure, please discuss with your physician or contact our clinic for information.

Dr. Von Bergen performs the majority of his procedures at American Family Children's Hospital, but has also traveled to hospitals in Iowa, South Dakota and Nevada, which has provided him with significant clinical experience and an especially high procedural volume for pediatric electrophysiologists.

If you would like to discuss Wolff-Parkinson-White Syndrome, please contact the clinic. The Wolff-Parkinson-White clinic is currently once a month on Tuesday, but special arrangements can be made if necessary. Phone consultation can also be arranged in special cases.