Wolff-Parkinson-White Syndrome Presenting with Antidromic Atrioventricular Re-entrant Tachycardia in a Haemodynamically Stable Patient

Clinical scenario

This protocol addresses the management of Wolff-Parkinson-White (WPW) syndrome when the patient presents in antidromic atrioventricular re-entrant tachycardia (antidromic AVRT) without haemodynamic instability. Antidromic AVRT occurs in a minority of patients with WPW syndrome and requires a targeted therapeutic approach distinct from the more common orthodromic form.

Specific clinical situation

The patient is haemodynamically stable — there is no haemodynamic instability requiring emergency intervention. The rhythm is confirmed antidromic AVRT in the context of known or suspected WPW syndrome. Treatment selection in this scenario must account for the accessory pathway physiology and the stability of the patient's haemodynamic status.

Treatment approach (partial overview)

The full structured protocol outlines a stepwise approach for this scenario. An intravenous agent is included among the options addressed — the complete regimen, sequencing, and clinical decision criteria are available in the protocol.

Full algorithm, agent selection criteria, and sequencing not shown here →

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References

DOI: 10.1093/eurheartj/ehz467

Antidromic AVRT occurs in 3–8% of patients with WPW syndrome.

In antidromic AVRT, i.v. amiodarone may be considered in refractory cases.

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