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The Informed Parent

Wolff-Parkinson-White Syndrome

by Louis P. Theriot, M.D., F.A.A.P.
Published on Feb. 25, 2002

It was a warm September evening last year, a Tuesday to be exact, when my family came together, preparing to sit down for dinner. My wife and I have three boys, ages 17, 15, and 11 years. The oldest is a senior in high school, the middle son is a sophomore, and the youngest is in the sixth grade. All three are involved in sports, which makes dinner time a wonderful opportunity for us to catch up on their activities of the day, both academically and athletically.

There was nothing out of the ordinary about this particular evening. In fact, our middle son was excited about his first football game, which would take place in two days. He was very animated telling us about how well practice had gone that day, and how he couldn’t wait for game day. Then, in an undaunted voice, almost as an aside, he said, “Oh yeah! My heart was beating all crazy today.” It took a second for this information to register with me. I looked at him and said, “What did you just say?”

He merely shrugged his shoulders and said, “It wasn’t a big deal, but my heart was beating really funny today. Anyway, I’m going to go shower before dinner.” He took off his shirt and started to walk out of the room. At once I intercepted him before he could round the corner. As I inspected his chest I could see an actual fluttering movement just below his left breast. It was moving like a bag of worms with no particular order. Taking his arm to feel for a pulse it was impossible to discern any rate. Retrieving my stethoscope I listened to his heart. The heart sounds were literally bouncing all over the sounded like a pair of tennis shoes that are in the dryer.

Upon conferring with my partner we immediately got my son to the emergency room. The boy looked great, had absolutely no symptoms, and was certainly in no distress. The ER doctors knew that we were coming. As I introduced him to my colleagues, one sensed that they were perplexed as to why we were son looked so healthy.

“We’ll just get his blood pressure,” the ER doctor said as she started to take some history. The nurse kept putting the BP cuff on, and then taking it off. She would put it on, and again take it off. She told the ER doctor, “I can’t get blood pressure on him.”

While all this was happening, someone else had put heart monitor leads on my son’s chest and had hooked him up to the monitor. “Doctor, you better check this out,” the nurse said with urgency in her voice. Sure enough, the monitor looked like a Richter scale tracing during an earthquake. It said that the heart rate was between 280-300 beats per minute. My son’s normal heart rate is about 56 beats per minute.

Instantly he had an IV in both arms, and the doctors were pushing medications to stop his supra-ventricular tachycardia, SVT. This is a condition whereby the heart loses its regulatory control and starts to beat on its own, in a random and haphazard manner. In retrospect, although his heart was racing at nearly 300 beats a minute, he didn’t have any symptoms whatsoever. That was because about 60 of these beats were actually effective heartbeats, which were close to his normal heart rate. My son was not nearly as frazzled as I was, or the doctor treating him.

To make a long story short, he was placed in the intensive-care-unit. After approximately seven hours and three different drugs the heart converted to normal rhythm. An echocardiogram revealed that his heart was structurally normal. But the EKG showed that he had Wolff-Parkinson-White syndrome, WPW. He was placed on a medication to regulate the heart rate, and he actually played in his game the next day.

WPW is a not-so-rare condition that occurs in otherwise healthy individuals. The heart is made up of four chambers. The two atria sit on top of the two ventricles, which are the main pumping chambers of the heart. The atria and the ventricles beat in a coordinated fashion to facilitate the flow of blood throughout the body. This is regulated by electrical impulses that are passed through a sort of wiring system in the heart. The sino-atrial node (SAN) is positioned in the upper part of the right atrium. When this fires, it causes the atria to beat and this pushes the blood into the ventricles. Then, the atrio-ventricular node (AVN), which is located above the ventricles, fires, causing the ventricles to contract. This sends the blood through the major blood vessels throughout the body. The timing of the impulses of the SAN and the AVN are closely regulated by the body. [click to view illustration]

In WPW, there is an extra little pathway that exists somewhere in the left ventricle; occasionally in the right ventricle. This pathway is somewhat of a maverick in that it should not be there. When the conditions are right it can beat on its own, independent of the SAN or the AVN. When this happens a “circus movement” or circular motion occurs, by which the normal regulated heart rate is overridden by this maverick pathway. This causes the supraventricular tachycardia that my son experienced.

Some of the triggering factors for SVT can be an adrenalin surge, which probably caused my son’s SVT during football practice, caffeine, ephedrine or amphetamines. There are a number of medications that are available to prevent the SVT that can occur in WPW. If one chooses to treat this condition medically, however, these medications must be taken for the rest of one’s life.

In the case of my son, he is a sophomore in high school and plays three sports: football, basketball and swimming. He was less than thrilled at the prospect of being on a medication for the rest of his life. The cardiologist felt that he was a prime candidate for an invasive procedure to correct the WPW, once and for all. We went to a sub-specialist, an electro-cardiologist, who examined the boy and agreed. The procedure, known as radio-ablation therapy, carries a very low risk, and will essentially cure the WPW. In ablation therapy, a catheter is passed through a vein in the groin or in the neck, up into the heart. This catheter records the electrical impulses of the heart and can actually “map out” the circuitry of the heart. The maverick pathway of the WPW can be identified, and with radio waves can be destroyed. When this is completed, the WPW no longer exists, and the need for medication is avoided.

My son was thrilled to learn of this option and is looking forward to the ablation procedure in one month. The cardiologist recommended waiting until after basketball season to have this done. He may need to be on aspirin for a month after the procedure, and one needs to avoid any bruising from a contact sport. This should not interfere with his swim season, which follows.

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