Catheter ablation is a widely adopted and effective treatment for Wolff-Parkinson-White (WPW) syndrome, an electrical abnormality of the heart that can lead to rapid heartbeats. While ablation is highly successful, recurrence is a known possibility. This article explores the nature of WPW, the ablation process, the potential for recurrence, how it is identified, and subsequent management options.
What WPW Ablation Entails
Wolff-Parkinson-White syndrome is a congenital condition with an extra electrical connection, an accessory pathway, in the heart. This pathway bypasses the heart’s normal electrical system, causing impulses to travel too quickly and lead to rapid heartbeats, or tachyarrhythmias. These episodes can manifest as palpitations, dizziness, or shortness of breath.
Catheter ablation is a minimally invasive procedure that treats WPW by eliminating this accessory pathway. Thin, flexible tubes called catheters are guided through blood vessels to the heart. Once the accessory pathway is located using electrical mapping, energy (heat or cold) is delivered through the catheter tip. This energy creates a small scar that blocks abnormal electrical signals, restoring the heart’s normal rhythm.
The Reality of Recurrence
Despite high success rates for WPW ablation (typically 94-97%), recurrence of the accessory pathway is possible. Studies indicate recurrence rates are generally low (4.9-6.2%). However, recurrence rates can vary, with some pathways, such as those in the right ventricle, showing higher rates.
Several factors contribute to recurrence. The most common reason is incomplete ablation, where some conductive tissue of the pathway remains viable and reactivates. Rarely, scar tissue from the ablation might heal in a way that allows electrical conduction to resume through the treated pathway, known as reconnection or regrowth.
The presence of multiple accessory pathways, not all identified or successfully ablated, can also lead to perceived recurrence. Rarely, a dormant or new accessory pathway could become active. Most recurrences are detected early, within the first few weeks or months, though late recurrences are uncommon.
Identifying and Confirming Recurrence
If WPW recurs after ablation, individuals typically experience symptoms similar to those felt before the procedure. These include fast, pounding, or fluttering heartbeats (palpitations), dizziness, lightheadedness, shortness of breath, or chest discomfort. In severe instances, fainting (syncope) may occur.
Should these symptoms reappear, seek medical attention promptly. Healthcare providers will evaluate the heart’s electrical activity to confirm recurrence. An electrocardiogram (ECG) is often the first step, revealing the characteristic “delta wave” associated with WPW. For intermittent symptoms, a Holter monitor or event recorder may track heart rhythms. If non-invasive tests are inconclusive, an electrophysiology (EP) study can map the heart’s electrical activity and confirm the accessory pathway’s function and location.
Addressing Recurrent WPW
When WPW is confirmed to have recurred after an initial ablation, a repeat ablation procedure is frequently the most effective course of action. This second procedure often has high success rates and can effectively eliminate the persistent accessory pathway. Advances in mapping and ablation techniques continue to improve outcomes for repeat procedures.
For some individuals, especially if symptoms are infrequent or mild, antiarrhythmic medications may be prescribed to manage heart rhythm. These medications help control heart rate and rhythm, reducing symptomatic episodes. While lifestyle adjustments, such as stress management and avoiding stimulants, can support overall heart health, they are not a primary treatment for recurrent WPW. Consult a heart rhythm specialist (electrophysiologist) to determine the most appropriate treatment. Even with recurrence, WPW remains manageable, and a positive long-term outcome is expected with proper medical care.