Treatment of Wolff-Parkinson-White Syndrome with Symptomatic, Recurrent Atrioventricular Re-Entrant Tachycardia
When Wolff-Parkinson-White (WPW) syndrome presents with symptomatic, recurrent atrioventricular re-entrant tachycardia (AVRT), a structured, evidence-based approach is required to guide management decisions.
Clinical Scenario
This protocol is directed at patients with WPW syndrome who experience symptomatic, recurrent AVRT. In this setting, catheter ablation of the accessory pathway is the recommended intervention.
Treatment Approach
Where ablation is not the chosen or feasible option, pharmacological management may be considered. Agent selection is informed by resting ECG findings and by the presence or absence of underlying cardiac disease — the two key determinants that shape which class of medication is appropriate.
The complete structured regimen — including specific agents, precise selection criteria, and the full clinical algorithm — is available in the protocol below.
References
DOI: 10.1093/eurheartj/ehz467
- Catheter ablation of AP(s) is recommended in patients with symptomatic, recurrent AVRT.
- Beta-blockers or non-dihydropyridine calcium-channel blockers (verapamil or diltiazem in the absence of HFrEF) should be considered if no signs of pre-excitation are present on resting ECG, if ablation is not desirable or feasible.
- Propafenone or flecainide may be considered in patients with AVRT and without ischaemic or structural heart disease, if ablation is not desirable or feasible.
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