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Wolff-Parkinson-White syndrome

Key sources
The following summarized guidelines for the evaluation and management of wolff-Parkinson-White syndrome are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2020), the American Heart Association (AHA/HRS/ACC 2016), and the Heart Rhythm Society (HRS/PACES 2012).
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Guidelines

1.Diagnostic investigations

Electrocardiography: as per ESC 2020 guidelines, consider obtaining noninvasive evaluation of the conducting properties of the accessory pathway in asymptomatic patients with pre-excitation.
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2.Diagnostic procedures

Electrophysiology study: as per ESC 2020 guidelines, conduct an electrophysiology study using isoprenaline to risk stratify asymptomatic patients with pre-excitation having high-risk occupations/hobbies, and those participating in competitive athletics.
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3.Therapeutic procedures

Catheter ablation: as per ESC 2020 guidelines, perform catheter ablation in asymptomatic patients if electrophysiology testing using isoprenaline identifies high-risk properties, such as:
shortest pre-excited RR interval during AF ≤ 250 ms
accessory pathway effective refractory period ≤ 250 ms
multiple accessory pathways
inducible accessory pathway-mediated tachycardia.
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4.Specific circumstances

Patients with pre-excited atrial fibrillation, pharmacologic management
Consider administering IV formulations of the following medications for acute management of hemodynamically stable patients with pre-excited AF:
ibutilide
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procainamide
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flecainide
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propafenone.
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Do not use IV amiodarone in patients with pre-excited AF.
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5.Follow-up and surveillance

Observation: as per ESC 2020 guidelines, consider obtaining clinical follow-up in asymptomatic patients with pre-excitation and a low-risk accessory pathway at invasive risk stratification.
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