What are the ways to manage Wolff-Parkinson-White syndrome?

Question

Hello doctor,

I am a 30-year-old male and a competitive athlete. I do not have any structural or plumbing heart issues. I was diagnosed with Wolff-Parkinson-White (WPW) syndrome accidentally, and I am waiting for an ablation in 17 days. I am mostly asymptomatic and have never experienced extremely rapid heart rates. My resting heart rate is actually in the 40s. However, I do sometimes have palpitations and occasionally experience runs of five to seven beats in a row. The electrophysiologist (EP) I saw in the hospital prescribed Flecainide 50 mg twice daily. I also consulted another EP, who was much older, for a second opinion. He seems to think I do not need Flecainide, and perhaps not even the ablation. I disagree with him regarding the ablation due to recent medical studies on WPW, which recommend ablation even for asymptomatic patients, especially athletes.

My question is about Flecainide. I have not experienced any palpitations since I began taking it a few days ago, but I want to ensure that this medication does not put me at risk of developing a dangerous arrhythmia. After reviewing case studies and medical journals, I see that there may be some risk involved. I have not been known to go into atrial fibrillation (AF), and aside from the palpitations, I am asymptomatic with WPW. Do you think that taking Flecainide at this dosage is safe and reasonable for the next two weeks until my ablation?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

In Wolff-Parkinson-White (WPW) syndrome, there is a possibility of rhythm disturbances and cardiac rate changes, which are episodic in nature. It can present as palpitations, but the timing cannot be predicted. Regarding Flecainide, I do not believe you need to continue taking it for the next two weeks. However, your cardiologist, who will perform the surgery, is the best judge to advise you on whether to continue it prophylactically.

I hope this helps you.

Thank you.