Pediatric Heart Expert Forum
Confused about WPW Syndrome & Ablation
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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Confused about WPW Syndrome & Ablation

Last December my son was diagnosed with WPW Syndrome.  He was seeing a pediatrician for another health problem (low iron).  My son complained of chest pains so the Doctor ordered an ECG which revealed he had WPW Syndrome.  My son will be turning 16 years old in a couple of weeks.  My son is relatively healthy (other than always having low iron), he is very active (hockey, track, basketball etc.).  He has no other symptoms associated with this syndrome (no fainting, no rapid heartbeat).  It was also discovered that he had H. Pylori and has been treated for this.  His followup revealed the h. Pylori has cleared.  But he still has low iron.  He would like to get the ablation procedure done.  Should he get the ablation even though he shows no symptoms?  What if the ablation does not correct his problem?  We are so confused but that is all he wants for Christmas he said, to have his heart fixed  :(    Any advice would help..thank you.
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Dear Braveheart,

This is an issue that has not yet come to consensus.  Wolff-Parkinson-White syndrome (WPW) exists when there is an extra electrical connection between the top and the bottom of the heart AND you can see evidence of its presence on ECG.  It is associated with an abnormal arrhythmia called supraventricular tachycardiac (SVT).  However, it can also cause problems if there is a different arrhythmia, such as atrial flutter or atrial fibrillation.  Even in asymptomatic patients with WPW, there is a cumulative risk of sudden cardiac death as one gets older.  And, the only way to ascertain whether the extra pathway is safe to leave alone or requires ablation is to perform an electrophysiology study (electrical mapping of the heart).  What ends up happening, though, is that often, since the cardiologist is already there mapping the heart, they usually just recommend going through with the ablation anyway.  That way, since you've already gone most of the way, you finish the job and be done with it.  Even if the pathway is in a location where it cannot be completely ablated, the pathway may be able to be substantially modified so that it makes it a weak pathway and eliminates his risk of sudden cardiac death.

This is not how everyone approaches this disease process, so it would be important to talk with a pediatric electrophysiologist (a peds cardiologist specializing in these procedures) for more information.
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