From the Guidelines
Wolff-Parkinson-White (WPW) syndrome itself is not treated with anxiety medications, as it's a heart condition characterized by an extra electrical pathway in the heart, and the primary treatment for WPW syndrome is catheter ablation as first-line therapy, as recommended by the acc/aha/esc guidelines 1. However, patients with WPW may experience anxiety due to symptoms like palpitations or worry about their condition. For anxiety related to WPW, standard anxiety treatments can be used, including:
- Selective serotonin reuptake inhibitors (SSRIs) like sertraline (50-200 mg daily) or escitalopram (10-20 mg daily)
- Benzodiazepines like lorazepam (0.5-2 mg as needed) for acute anxiety episodes
- Cognitive behavioral therapy (CBT) is also highly effective, typically involving 8-12 weekly sessions It's essential to note that some anxiety medications, particularly tricyclic antidepressants, should be used cautiously in WPW patients as they may affect heart rhythm, and beta-blockers, sometimes used for anxiety, should only be used under careful cardiac supervision in WPW patients, as stated in the guidelines for the management of patients with atrial fibrillation 1. Any anxiety treatment should be coordinated between a mental health provider and the cardiologist managing the WPW condition to ensure safety and effectiveness of the overall treatment plan.
From the Research
Treatment for Anxiety in Wolff-Parkinson-White (WPW) Syndrome
There is no direct evidence on the treatment for anxiety in Wolff-Parkinson-White (WPW) syndrome. However, the following information on the treatment of WPW syndrome may be relevant:
- The treatment for WPW syndrome includes short-term therapy such as vagal maneuvers, atrioventricular nodal blocking agents, or direct current cardioversion 2.
- Long-term therapy includes antiarrhythmic therapy, and surgical or catheter ablation 2.
- Catheter ablation is the most effective means of achieving reduction in symptom burden and attenuation of the risk of pre-excited atrial fibrillation 3.
- Radiofrequency catheter ablation remains the first-line therapy for patients with symptomatic WPW syndrome 4.
- Medication is often employed in the acute setting to terminate paroxysms of arrhythmia associated with the accessory pathway and reduce the subsequent burden of symptoms until ablation can be performed 3.
- Procainamide is the safest drug for the stable WPWS patient with a tachydysrhythmia, including wide-complex and irregular rhythms 5.
- Verapamil is a useful drug in narrow-complex, regular rhythms, although complications have been reported 5.
Management of WPW Syndrome
The management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation 6.
- Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias 6.
- Invasive electrophysiological study and possible ablation of accessory pathway may be offered to well-informed asymptomatic individuals with WPW if they are willing to trade the very small risk of subsequent sudden death or incapacity for a small immediate procedural risk of serious complications or death 4.