SVT or WPW?

I am a 36 yo female that began experiencing palpitations 10 yrs ago. I consulted a cardiologist and had an echo, Holter and EKG. I was told everything was normal and the palps were benign. I reduced caffiene consumption and stress. The palps went away (atleast I stopped noticing them). I again experienced palps during my first pregnancy 5 years ago. An EKG performed noted I had a "borderline short PR interval and a normal sinus rhythm." A Holter test noted I had 3 SVT beats at 158 bpm (the longest and fastest svt run).I also had occasional PACs. I was told not to worry. Dr. did not mention the SVTs or PAC. During a c-section 6 wks ago, I felt a few palps (felt like my heart was flip flopping). The anestiologist stated I had a "delta wave" and should see a cardiologist. They did an EKG post-op which showed a "short PR interval and normal sinus rhythm." I saw an electrophysiologist who did another EKG showing again "a short PR interval(100ms) and normal sinus rhythm". He said I have a hint of a "delta wave indicating I have an accessory pathway, maybe WPW". Because I am not experiencing tachycardia he recommends no further testing or treatment. I have had no palps since the c-section. My questions...
1. When the dr asked if I ever had tachycardia I said no. Are the SVT beats I experienced during the Holter actually the kind of tachycardia associated with WPW?
2. Does this sound like WPW or another kind of SVT?
3. Do the recommendations of the electrophysiologist seem reasonable?  
4. Does this sound dangerous? What is my risk of sudden cardiac death?
Any input appreciate

[CCF-M.D.-RCJ]

maof3,

Thanks for the post.

Q1:"Are the SVT beats I experienced during the Holter actually the kind of tachycardia associated with WPW?

Perhaps, but 3 beats would not be enough to act upon.

Q2:"Does this sound like WPW or another kind of SVT"

3 beats is undiagnosable, and not enough to worry about.

Q3:"Do the recommendations of the electrophysiologist seem reasonable?"

Yes.

Q4:"Does this sound dangerous? What is my risk of sudden cardiac death?"

No, it does not sound dangerous.  As you are over the age of 35, and have never experienced clinical tachycardia, you are at low risk of complications from WPW, if indeed that is what you have.  The recent New England Journal of Medicine article that performed prophylactic ablation on patients with clear electrocardiographic WPW included patients over the age of 35 in the low-risk group.  Only 6 of 148 patients developed clinical tachycardia, and no adverse complications were noted.

Hope that helps.

[CareBear59]

Hello,
I am so glad this question was posted because I also have a short PR interval on my EKG's but no Delta Wave that they have ever mentioned and I've been to many cardiologists and electros.
I do have SVT and they've never said that I had WPW.  So I'm wondering, can they always tell if you have the WPW kind from event monitors, holters, and resting ekg's.  HELP!!

Carrie

[LynnSB]

No. WPW can NOT always be identified from EKGs, event and holter monitors, etc. -- usually, but not always. An EP study would be the definitive test for WPW.

[LynnSB]

I guess I should add that it is my understanding that WPW is not always seen on an EKG, although it usually is. I'm sure the good doc will jump in with a definitive answer shortly.

Also, it is my understanding that finding abnormal delta waves on an EKG alone doesn't mean you have WPW. I believe it can mean you can have another kind of reentry tachy and  preexcitation without having WPW.

Again, wait for the doc's reply for a definitive answer!

[Maof3]

Thanks to everyone who responded. I gather from the drs I visited and the one who responded that there is not enough information to make a diagnosis. However, what other diagnosis besides wpw could fit my history? What else can a short PR interval indicate other than wpw?

Also, does anyone know if your PR interval can change over time? I've had several ekgs over the past 10 years as part of my annual physical and never, besides the one during my pregnancy  in '95 and now, have I been told I have a short PR interval. Also in '95 it was considered "borderline short".

I'm a mother of three and very scared about future arrhythmia problems!

Thanks again to all!

[CCF-M.D.-RCJ]

I'll try to clarify a few points.

A short PR interval means nothing by itself.  And delta waves are not always clearly diagnosable.

WPW is a clinical syndrome correctly diagnosed when someone had a clear-cut delata wave, short PR interval, and an SVT.

Maof3 does not clearly meet this criteria, from the information provided, but her history is not inconsistent with the diagnosis.

Hope that helps.

[reedsgr1]

Hankstar-
Thank you for your response yesterday to my irregular EKG and stress and thallium tests.  I am thinking that I just have a normal variant.  

I have one follow up question for you.  If I have an EF of 65%, does that indicate that my heart wall motion is normal??  Can you have a good EF and still have underlying heart issues?
Thanks!