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Forum Name: Arrhythmias

Question: Wolff Parkinson White Syndrome and Paxil


 jhutch - Fri May 01, 2009 12:07 am

My daughter was born in Dec of 2001. She seemed to be very healthy with no major illnesses until the past coulple of years. It started just sitting at the table and she all of the sudden screamed in pain and grabbed her chest. As I put my hand on her chest I noticed it was was beating very rapidly and hard. It lasted for a couple of minutes and passed. It happened again the next week so I took her to our PCP. They ordered an ekg and a sonogram of her heart. All tests came back normal. It continued to happen occasionally. Sometimes weekly, sometimes monthly. My PCP sent her to a childrens cardiologist where they performed an ekg again and recommended that she wear an event recorder to try and catch the problem. After wearing the recorder for a few months we were not successful on getting a reading. The episodes seemed to slow down but have never stopped completely. It has been about two years and they are starting to happen more frequently again. The most recent episodes have been two weeks ago and today. By the time I got her to our PCP, it had passed.
In the last week while watching TV with my husband a commercial came on about Paxil and heart defects in children. I knew I had taken it for a about three months but couldn't remember the time to be exact. After contacting my OBGYN today, I was told that it was prescribed to me on 9-27-01. My heart sank and I have been doing some research online since. Today my PCP said her file from the cardiologist mentions Wolff Syndrome and Supraventricular Tachycardia. What is the difference between the two and what tests can be done to diagnose her for sure? We head back to the cardiologist next week and I would appreciate any advice. Thank you for your time.
 John Kenyon, CNA - Sat May 02, 2009 9:58 pm

User avatar Hi there --

While there are some teratogenic adverse side effects (potential birth defects including those involving the heart) in the literature on Paxil, what you've found in your daughter's records would likely not be related to the Paxil use, which had generally caused structural defects. Also, WPW generally shows up a little later, usually in early adolescence (but of course there are exceptions). I'm not certain why this would have been noted in the cardiologist's records, since nothing was found, unless it was intended as a "note to self" to try and rule out WPW and/or SVT which might explain her odd episodes.

Since you personally were able to detect rapid and forceful beating of the heart, and since the onset of arrhythmias associated with WPW as well as SVT from any cause may be sudden, startling and frightening, your daughter might well, at her age, react with a cry of alarm at onset of a brief burst of such rapid or irregular beating. In fact, based on the limited description you've provided this has probably been sudden, brief episodes of a tachyarrhythmia, probably SVT.

Now the good news: SVT, while extremely unpleasant feeling, is generally not life-threatening, although it can be very disruptive to whatever activity is going on when it happens. Some people, children included, may have random attacks of this, often for no discernable reason. Structural defects have been ruled out, so the only other possibilities are idiopathic (no known reason), or an abnormal re-entry or bypass tract, defects which would not likely be caused by Paxil use, but which are often found at random in the general population, sometimes as an inherited thing.

WPW is another story, and young people who have it do need to have it managed til they''re old enough to have it corrected permanently (a fairly simple in-and-out procedure). But I think the cardiologist was simply thinking out loud about this, and if you check with either him or the PCP you might ask why the mention of it, since it is very easy to detect on EKG, haviing a characterisitc "trademark" delta wave. If this is present then so is WPW, and it can be managed with medication until the child is old enough to undergo radio frequunecy ablation (RFA) to cure it.

These sorts of episodes can be so random, especially the less troublesome atrio-ventricular nodal re-entry tract (AVNRT)- caused SVT, that it may be by luck alone that it is caught on a monitor's strip. (AVNRT is cured the same way as WPW but is less potentially serious).

I hope this helps. Please follow up with us here as needed and please keep us updated as well. Good luck to you and your daughter.
 jhutch - Sat May 09, 2009 12:57 pm

First of all, thank you for responding to my questions. My daughter had her appointment with the cardiologist this past week. They did another ekg on her and did rule out the Wolff Syndrome. She agreed that the paxil probably has nothing to do with my daughters racing heart. She recommended that she wear the event recorder for two months to see if we can get a good reading on what's going on. Since there is nothing structurally wrong with her heart she assured us that whatever it is, it is not life threatening and it is fixable. We are hoping to catch something on the event recorder this time to confirm a diagnosis. In the meantime she said our daughter is healthy and to continue on as usual and not to worry. I will keep in touch and let you know how things are going. Thanks again for your response.
 John Kenyon, CNA - Sun May 10, 2009 1:12 pm

User avatar Wonderful news! Thanks for this update. The event recorder makes perfect sense and is only a minor inconvenience most of the time. It may also capture, eventually, what's causing the tachycardia. This may, in fact, be AVNRT, which is not life threatening but also doesn't have much of an EKG "signature" like WPW, so if that's the case it would likely require capturing an event. That's the frustrating part, since this can be such a random-occurring thing. Good luck with this and I'm very happy to hear all the truly scary stuff has been ruled out. Glad you'll be keeping us update.

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