This protocol covers WPW syndrome when it manifests as antidromic atrioventricular re-entrant tachycardia (antidromic AVRT) in a patient without haemodynamic instability. Antidromic AVRT is an uncommon but recognised presentation, occurring in 3–8% of patients with WPW syndrome.
In antidromic AVRT, conduction proceeds anterogradely via the accessory pathway, producing a wide-complex tachycardia that differs from the more common orthodromic form. Haemodynamic stability in this context permits a stepwise approach before escalating to more aggressive intervention.
When vagal manoeuvres and adenosine are insufficient, specific intravenous antiarrhythmic agents or electrical cardioversion may be considered. The full regimen — including agent selection criteria, sequencing, and decision points — is detailed in the complete protocol.
DOI: 10.1093/eurheartj/ehz467
Antidromic AVRT occurs in 3 - 8% of patients with WPW syndrome.
In antidromic AVRT, i.v. ibutilide or procainamide or i.v. flecainide or profanenone or synchronized DC cardioversion should be considered if vagal manoeuvres and adenosine fail.
View source ↗