Wolff Parkinson White Syndrome

bs147

Hi - I have just been diagnosed with Wolff Parkinson White Syndrome (irregular and racing heart beat due to confused electrical signals in the heart). I was rushed to hospital on Monday night with heart rate jumping all over (never below 150) - I was given electric shock treatment (jump re-start!) to reset the electrical pulses in the heart to normal. I am to undergo an operation in a couple of months to correct the problem but was curious to know if anyone here has any first hand experience of it and how it affected their cycling once cured (what was the recuperation period, etc). Thanks in advance for any comments anyone may have.

dazccp

Hi i found out i had wpws 12 months ago,i'm currently waiting for the op anytime between august and march.i have been told that once i've had the op the bike will be no problem at all ,they said it will be a case of letting where they go in through the groin to heal,then back to normal.i have still been riding my bike for the last 11 months, the doc said it's fine to carry on biking as it help keeps heart strong,they advised me to wear a heart rate moniter ,and they worked out that if i keep below the rate they worked out for me i would be fine.i have had no problems since and am still enjoying biking whilst waiting for the op.

bs147

Hi - thanks for that - re-assuring to know that relative normality can continue. Did you have 'a fibrillation event' - as the medics call it - or massive palpitation attack as non medical types would call it? The doctor said that it is easy to pick up on an ECG and most frequently 90% of people don't know they have it. He said I was high risk so I should be getting it done in 2-3 months... I've had palpitations since i was 18 (I'm now 36) so it will be nice to clear that up after all this time!

dazccp

Hi yes i did have a fibrillation event i was 38 at the time,i had some when i was about 18 but the doc put it down to me just drinking coffee and coke all the time.when i was told i had it last year i felt my life had been turned upside down,i always felt so fit from biking to then be told i had a heart problem.i then did the worse thing and check out the internet,you seem to read about the worse cases.After going to see the doctor at broadgreen my mind was put at ease that for a heart problem it is a small problem which can be repaired fairly easy with very little problems after.It is down to welsh poltics why i have to wait for my op,as i'm having it done in liverpool hospital the welsh assembly don't like paying so i can end up waiting a extra 6 months.

cookiemonster

Hello

Well you all have me to thank for the cure

I was one of the guinea pigs for the original procedure, maybe 16, 17 years back. Problem solved, though i have a bit of an odd heart trace apparently - and I'm told that the procedure today is way more advanced. I had wpw through my teens - bonkers rates, would go up to 200 and stick there for 8 hours - finally got referred to the program at st marys when I was 20.

It makes absolutely no difference to fitness (I'm still as unfit as I would be if i hadnt had it ); nah - I've run, swam, cycled etc and generally kept well above average fitness without any irregularities. In some ways I think ive stayed fit because of it - just a mental awareness that I want to keep my heart in condition.

The only risk from it as far as I know was that your heart could possibly through a clot if its up at silly speed for a long long time,

Nowt to worry about, and no, sorry you cant blame being crap on it either

The procedure is a bit weird though - not painful, not scarey, just odd. At least the bit where they stop your heart for 5 - 10 seconds to make sure they've solved it. Not many people get a chance to be dead and then talk about it


jon

Dr_Death

First of all I thought I'd talk a bit about normal elctrophysiology of the heart (makes understanding WPW easier).

Your heart is broadly divided into top and bottom halves and left and right halves. The top half (the atria) accept blood as it returns from your body (right) and your lungs (left). The top half contracts to force blood down into the bottom half (the ventricles) which then contract to send blood off to your lungs (the right) and around your body (left).
Obviously if the whole thing contracted all in one go it wouldn't be very efficient and the top has to therefore contract slightly before the bottom. So, how does it do this? It is basically controlled with electrical waves of activity. In a normal heart a wave starts in the atria (the right atrium to be exact) and spreads throughout them both. The ventricles are insulated from the wave by a layer of non-conducting tissue apart from a small pathway. The electrical wave finds this but is held up at it for a brief moment and then spreads down through the ventricles. This is why, if you listen to someones heart beat you hear two beats (commonly described as lub-dub) one is the atria contracting, then a brief pause and the ventricles contract.

In WPW there is what is known as an accesory pathway. This is an extra conection between the atria and the ventricles that shouldn't really be there. The electrical wave from the atria can also find it's way down here as well as down the normal pathway. Normally this doesn't really cause any problem, in fact 0.25% of you reading this will have it!
However this accesory pathway doesn't have the ability to pause the electrical wave for a moment like the proper pathway does so it causes what is known as pre-excitation. This means the ventricle starts to contract before it is supposed to, again not normally a problem as the heart is pretty efficient and robust. These pre-excitation waves can be seen on an ECG as specific changes to one of the electrical waves and is usually the way that these things are picked up.

So, what happens when you get these palpitations. Basically the electrical wave has gone a bit hay wire. As stated above it should start in the right atrium, spread through the atria, pause at the atrio-ventricular node and then spread down through the ventricles and stop. Repeated about 60-70 times per minute. In WPW the signal gets lost; it starts in the right atrium as normal, spreads through both atria, and then does one of two things (depending on your sub-type of WPW) it either goes down the normal pathway and back up the accesory pathway, or down the accesory pathway and back up the normal pathway. Either way it sets up a re-entry tacchycardia where the electrical conduction wave continues to go round and round in circles up one pathway and back down the other.

In the acute phase you can treat these by giving you fun drugs that stop your heart for a second and allow it to sort itself out, or by electricuting you to re-start the heart. Neither of these are things that you would want to continue doing on a long term basis so they tend to offer a more permanent solution such as RF ablation - which I'm assuming is what you've been offered.

Radio-frequency ablation involves two parts. First they need to find exactly where the pathway is, they do this by inserting sensing electrodes into your heart trhough one of the big veins at the top of your leg (femoral vein). Once they have located exactly where the pathway is they stick an ablation catheter into the middle of it and send radiofrequency waves down it and fry it (bit like microwaving it). Once it has been fried it scars and doesn't conduct any more.
So, how good is RF ablation? Depends on where the accesory pathway is: the location of the accessory pathways, in descending order of frequency, is (1) the left free wall, (2) posteroseptal, (3) right free wall, and (4) anteroseptal. According to a large study from the states; for left free wall accessory pathways, 2312 of 2527 patients (91%) were cured. For septal accessory pathways, 1115 of 1279 patients (87%) were cured. For right free wall accessory pathways, 585 of 715 patients (82%) were cured. So all in you have a bout a 90% chance of cure. With only a 1 percent chance of complications.

So, back to your original question (if your still out there), according to a very relialble source:

Patients presenting with tachycardias and accessory pathways should avoid participating in competitive sports because catecholamines can decrease the refractoriness of the bypass tract and facilitate tachyarrhythmias.

but

Once a curative procedure (eg, RF ablation of the accessory pathway) has been successfully performed, most patients can return to competitive sports several months later.


Hope this helps........

bs147

Hi -thanks for taking the time to present the very thorough explanation and information - I'm sure others will also have found it interesting! I am due to have the RF ablation procedure in the next 2-3 months and am naturally hoping it is an effective cure. I'm told that the recovery period is short and only really related to the catheter entry point healing. You mentioned that competive sports can be resumed within a couple of months - is that a heart recovery time? Having had a cardioversion two weeks ago I am returning to the gym for light cardio work this week - I've just been walking for an hour a day (at least) in the meantime. The cardiologist that dealt with me said just to not go too mad with the heart rate - I suggested less that 150 bpm and he seemed to think that sounded sensible. Does this sound approximately correct to you? I am taking flecainide (50mg twice daily).

Dr_Death

It has to be said if you cardiologist says that that is OK I would be very foolish to disagree with him as a lowly A&E doc.....


And by competitive I think the paper I scammed it from meant truely competitive i.e. serious training/racing. As with all advice metted out on an internet forum I'd double check with your cardiologist before making any big steps in your 'output'.

dazccp

hi how have you been getting on with your wpws have you been able to get out on your bike,have you had your op yet.
i,m going to broadgreen tomorrow to have rf ablation it will be good to get it out the way.going to get a quick bike ride in this morning before having time off bike after op.

bs147

Hi,

I had my ablation on November 8th and have recovered well from it. It took 4 hours to complete and i was let out that night. It was painful to walk to 4-5 days (they went into both legs) but quickly improved. The advice was to take it easy for a week and then get back to normal activity slowly. I've been going to the gym and using the bikes there - more controlled and can keep an eye on the heart rate. Two weeks on there is no upper leg discomfort. I will probably get outside on my bike this weekend. Others on here have advised 1-2 months before really going for it - sounds like good advice! Hope your procedure goes well!

Dr_Death

glad to hear that all went well (reassures me should I ever need it for my SVT). Glad to hear yo are getting back out on your bike as well (even if the weather is shitty).