Is Diltiazem safe for WPW pattern?

Question

Hello, Doctor,

I am a 32-year-old male, and at 25, I experienced sudden episodes of rapid heart rate while playing cricket, lasting about two minutes. After consulting a cardiologist, I was diagnosed with WPW pattern type A, but my ECG, echo, and treadmill tests showed no arrhythmias. Over the years, these episodes became more frequent, lasting 10 to 15 minutes, so my cardiologist prescribed Dilzem SR 90 mg and advised me not to play cricket for a month.

After a follow-up, I was told to continue the medication and return for checkups every four months. In the past 1.5 years, I have had three shorter episodes, all lasting two minutes and less intense. However, I recently came across articles stating that Dilzem should not be used in patients with WPW. I am confused and want to know if it is safe for me to take Dilzem SR 90 mg with my WPW pattern and if it helps prevent dangerous arrhythmias like atrial fibrillation or ventricular fibrillation.

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have been diagnosed with WPW (Wolff-Parkinson-White) pattern, which means you have an extra electrical pathway in your heart but have not experienced any dangerous arrhythmias during testing. This is different from WPW syndrome, where the extra pathway causes issues like atrial fibrillation or serious arrhythmias.

Based on your symptoms and tests, it seems your episodes are likely AVRT (atrioventricular reciprocating tachycardia), which causes short bursts of fast heart rate that resolve on their own. In your case, Diltiazem (Dilzem SR 90mg) is being used to help manage these episodes, as it can safely control AVRT without interfering with normal heart function. However, the risk of using Diltiazem is primarily associated with pre-excited atrial fibrillation, which you have not experienced.

As long as your ECGs and stress tests show no atrial fibrillation (AF) and you have regular monitoring, Diltiazem can be safe in your case. It will help prevent the AVRT episodes, but it does not prevent atrial fibrillation or ventricular fibrillation entirely.

Your doctor is likely aware of your WPW pattern and is keeping track of your condition. However, it is always a good idea to ask your cardiologist about the frequency of checks for AF while you are on Diltiazem. If you ever experience irregular or extremely fast heartbeats, seek emergency care, as it could signal AF with pre-excitation, and the medication would need to be adjusted.

I hope this helps.

Thank you.