Ariana Toth was an active 15-year-old high school student when she suddenly began having headaches, chest pain, lightheadedness and fainting spells.
“It was very scary,” says Ariana, now 17. “I had symptoms daily and would have to leave school quite a bit because I didn’t feel good.”
Her father, Michael Toth, says that Ariana “was tired all the time, and had heart palpitations for a few years.”
“The doctors didn’t know what it was at first,” Ariana says. Possibilities included anxiety and postural orthostatic tachycardia syndrome, which can cause similar symptoms. However, in March 2021, an EKG led to a diagnosis of Wolff-Parkinson-White syndrome (WPW).
Cleveland Clinic Children’s pediatric cardiologist Peter Aziz, MD, reviewed Ariana’s EKG, determined the likelihood of WPW, and quickly called the family.
“We were in a store when Dr. Aziz called us,” Michael says. “It caught us off guard. He noticed from her records that she’d been very active in sports. She was in competitive cheerleading, and he told us to have her stop immediately because she could have a cardiac arrest. As scary as it was, we talked to Ariana, and in the back of all of our minds, we were thankful that this was caught, that something was identified.”
Dr. Aziz says that Cleveland Clinic Children’s pediatric cardiology sees “quite a bit of this disease.” The syndrome, which develops before birth, affects one in 1,000 individuals. Patients of all ages have WPW, he says, including some in their 60s who, for various reasons, just had their first symptoms.
“When babies are developing in utero, the heart maturates, starting as a cluster of cells that slowly differentiate into separate chambers, tissue and vessels,” he says. “Sometimes, the heart doesn’t separate as it should, leaving tiny strings of cheese – the analogy we use – that remain attached to the upper and lower chambers, like extra wiring. A lot of people who have this may not know it or have symptoms.”
However, for some, this extra wiring is dangerous, Dr. Aziz says. “In 1% to 4% of those who have it, life-threatening events can happen. That may not sound like a lot of people at first, but if you take an otherwise healthy 17-year-old and say there is a 1-in-25 chance of a cardiac event, that’s significant.
“Once a patient is diagnosed, the next step is to figure out their risk. In the interim, we make recommendations based on the guidelines. For Ariana, that meant refraining from competitive sports until she was treated or the WPW was cured with an ablation procedure.”
"It’s a fresh start for her. We’re glad the problem was found, and Dr. Aziz is amazing. He treated Ariana as an individual, not a child, and let her know that her feelings actually mattered."
Two categories of symptoms should prompt an evaluation by a cardiologist or heart rhythm specialist, he says. “The first is passing out, which is a red flag in the context of physical or emotional stress. The second is palpitations or rapid heartbeat that occur abruptly or without warning. Even one occurrence is sufficient to warrant an evaluation.”
Ariana was evaluated and equipped with a heart monitor for the weeks leading up to an outpatient catheter ablation procedure, performed by Dr. Aziz on May 6, 2021. “We place catheters through a large vein in the groin, the femoral vein. That yields access to the heart and allows us to find the extra wires that are causing symptoms and get rid of them,” he says. “When we place the catheter on that particular piece of tissue and turn on an energy source, usually heat, it damages the electrical conduction properties of the tissue. It doesn’t destroy the tissue. It just eliminates its ability to act as a wire.”
She arrived for surgery early in the morning and was discharged that same afternoon, says Dr. Aziz, who performs about 70 to 80 ablation procedures a year, mainly for WPW syndrome.
“Cleveland Clinic historically has been a very high-volume ablation center,” he says. “For that reason, our Children’s physicians, anesthesiologists and nursing staff have a good background managing patients with arrhythmia disorders. We share our lab space with our adult medicine colleagues, which means we can collaborate with 20 world-renowned heart rhythm specialists. We also have access to all of the same tools and equipment that they do, which a lot of pediatric centers don’t have.”
After surgery, Ariana’s symptoms disappeared, and she was able to resume normal activities. “I noticed immediately that there were no more chest pains, and, in a few weeks, I felt good,” she says. “I am able to work out again, and I don’t really worry anymore.”
She will have yearly checkups, but Dr. Aziz says that there is a 95% chance that she never has this again.
For his part, Dr. Aziz says, “meeting someone like Ariana for the first time and explaining that they have a significant, life-threatening disorder — or telling a parent that we need to do a procedure on their child — is hard. It can be very alarming, disorienting and uncomfortable for a family to hear that. I appreciate Ariana and her parents, and the other patients whom we see, maintaining their objectivity and trusting us with their care. There’s really no bigger compliment than that.”
In June, Ariana celebrated her high school graduation with family and friends. In the fall, she plans to attend Kent State University, majoring in fashion design.
“It’s a fresh start for her,” Michael says. “We’re glad the problem was found, and Dr. Aziz is amazing. He treated Ariana as an individual, not a child, and let her know that her feelings actually mattered. That meant a lot. He has taken so much time to talk with me and my wife, Roni, to discuss the situation and answer our questions. He took what was a bad experience for us and made it a good one.”
Cleveland Clinic Children's ,
Heart, Vascular & Thoracic Institute (Miller Family)