Heart & Cardiology/WPW and possible ablation
I am 44 year old female with DX of WPW since I was 17 years old. I am followed by a cardio and EP.I have been asymptomatic until recently. It seems since I had my last child 7 years ago, I started to have episodes. They were infrequent. My EP felt since they were infrequent and not consuming my life and that the accessory pathway was close to main node, to leave well enough alone. However, last year they started becoming more frequent and I wasn't feeling right.I went through my usual series of tests with my regular cardio( ekg, sono, stress test etc) and passed all with flying colors. Was told my heart looks great. However, I kept having symptoms. I could now feel when I was in my pathway and when I was having an episode. It did not feel like tachycardia but more like a slow beat. When I would be tested, I was surely using the pathway. It was so bad one day that I could not get out of the episode and was taken by ambulance to ER. MY WPW was presenting. AS well as showing LBBB, but they told me that is just my WPW. My WPW is intermittent and does not always show on an EKG. However, I can tell when it is happening. Went back to EP who suggested an event monitor for 4 weeks. I had numerous episodes and on my follow up my EP suggests that it may now be time for an ablation. However, I have been feeling well for about 3 weeks. Had a couple episodes past few days. My question is this, since my WPW is intermittent, should I proceed with the ablation? I notice it more when I am stressed or when I am out in very humid hot weather. My EP said the good thing is that I am not continuously showing the WPW and that I do have breaks without it. He says by looking at event monitor recordings, the pathway may not be as close to the node as originally thought but would only know once ablation is started. He also says my event monitor showed episodes while sleeping. And on those days I do remember waking up extra tired. I am confused if now doing an ablation is the right avenue for me to take or do I wait and see how I do in the future since the last few weeks have been ok. Also, could low vitamin d be a trigger of WPW? Last, when I am having an episode, it knocks me for a loop and all I want to do is sleep after. Is that normal?
Hi Laura, http://myheart.net/articles/
You have symptomatic WPW. In asymptomatic WPW it is more controversial when to perform ablation, but ablation for treatment of symptomatic WPW is the generally preferred treatment. In your case, since the pathway is close to the node and the conduction system of the heart there is of curse a chance of heart block. Since the symptoms have developed, if your EP feels it is reasonable to proceed, and since you have had a conservative approach so far, it doesn't seem an unreasonable option. There is no known association of Vit d and WPW. If you are confused and since you have seen one EP already you can always seen another opinion. Its not really possible for me to give you a definitive opinion since i event seen you or the full details of the case. Alternatively see the same EP again and run through the pro and con of ablation prior to proceeding so you have a clear understanding and are more comfortable.
Hope that was helpful,