my son with wpw and a-fib

[jamieleereid]

My son was diagnosed with WpW at age 13.  He had a cardiac ablation 4 months later.  He is now 17 and started having issues with his rythm again.. His cardiologist states his wpw is not back , however he believes he has  a-fib issues now and that he always had it as an issue with his wpw... How common is this to have both?

[PikaPika88]

My wpw diagnosed at 15 yrs old.  I had a His bundle ablation at 27 yrs old.  Unfortunately, a new pathway grew during my heart block.  It is an anterograde pathway and it conducts very effective.  They let me kept it so I don't have to be a pacemaker dependent.  Now I'm 51, was diagnosed with A-Fib few years ago.  My cardio said, he is expecting the A-Fib.  I'm double protected by the pacemaker so far.  He said my wpw is intermittent.  Sometime can see on the ECG, sometime can't see on the ECG.

[Jeffrey R Boris, M.D.]

Dear Jamie,

I don’t have all the information on your son to be able to tell exactly what is or was going on with him, but I can make a few educated guesses.  Since you said that he started having issues with his rhythm “again”, I am presuming that his Wolff-Parkinson-White syndrome (WPW) came to light in the setting of an arrhythmia.  For our other readers, WPW is a disease process where there is an extra electrical connection or pathway between the atria (the upper heart chambers) and the ventricles (the lower heart chambers) in addition to the normal connection already there, the atrioventricular (A-V) node, AND there is evidence on the electrocardiogram of the extra pathway.  This extra electrical pathway can allow for two events associated with arrhythmias to happen.  The first, which is much more common, is atrioventricular reciprocating tachycardia (AVRT), in which electricity goes down one pathway and back up the other; this can cause rather fast heart rates of >180 beats per minute at rest.  Usually, though not always, this is more of a nuisance and is not life threatening.  AVRT is a form of supraventricular tachycardia (SVT).  The second event, which is less common (although it becomes more common as we age into later adulthood), is what occurs if you have atrial fibrillation (a-fib) or atrial flutter, which are also types of SVT.  A-fib and atrial flutter are very fast arrhythmias of that occur in the atria, in which the atrial rate can go 200 to 400, or more, beats/minute.  Our A-V node can’t conduct that quickly, so our ventricles don’t beat much over 200 to 220 beats/minute.  However, with the extra pathway provided by WPW, the electrical impulse can bypass the A-V node and cause the ventricles to beat as fast as the atria.  This can cause sudden cardiac death, as the ventricles going much faster don’t allow for an adequate amount of blood to be pumped out to the body.  This is one of the main reasons why patients with WPW undergo radiofrequency ablation, which burns the extra pathway and eliminates it.

Usually, we don’t see a-fib in children.  It tends to be a disease of older people, especially if they have coronary artery disease.  However, the one exception is that we can see a somewhat increased incidence of it in adolescent males.  That said, it is not particularly common.  Another instance where we can see a-fib in kids in the setting of WPW is if they have Ebstein’s anomaly of the tricuspid valve, which is an abnormality of the first valve on the right side of the heart accompanied by an abnormality of the right atrium and ventricle.  I don’t know for sure what your son’s initial arrhythmia was, though I would guess that it was likely AVRT and not a-fib.  Also, I don’t know if your son had associated Ebstein’s anomaly, which would have put him at a greater risk of a-fib.  Finally, a-fib and WPW have been seen together in kids; in one small series, it was seen in 4% of WPW patients.  The bottom line here is that it is probably a good thing that your son’s WPW pathway was ablated.  However, the a-fib will now have to be managed, which can be problematic.  Do discuss this with your cardiologist and make sure that you are happy with the education that you are being given, and don’t hesitate to question anything you don't understand.