Atrial fibrillation Wolff-Parkinson-White preexcitation syndromes


 * Associate Editor(s)-In-Chief: ; Varun Kumar, M.B.B.S.

Synonyms and related keywords: AF, Afib, fib

Overview
The incidence of sudden cardiac death is between 0% and 0.6% in patients with Wolff-Parkinson-White syndrome,   particularly those with short antegrade bypass tract refractory periods (less than 250 ms) and short R-R intervals during pre-excited AF (180 plus or minus 29 ms). In hemodynamically stable patients, intravenous procainamide may be administered to convert pre-exited AF to sinus rhythm. AV nodal blocking agents such as digoxin, diltiazem, or verapamil are contra-indicated as they increase AV-node refractoriness which could encourage preferential conduction over the accessory pathway. AF associated with a rapid tachycardia due to an accessory pathway may be treated with flecainide that has shown to slower the ventricular rate by prolonging the shortest pre-excited cycle length during AF and hence terminate AF.

==ACCF/AHA/HRS 2011 Guidelines- Wolff-Parkinson-White (WPW) Preexcitation Syndromes (DO NOT EDIT) == {{cquote|

Class I
1. Catheter ablation of the accessory pathway is recommended in symptomatic patients with AF who have WPW syndrome, particularly those with syncope due to rapid heart rate or those with a short bypass tract refractory period. (Level of Evidence: B)

2. Immediate direct-current cardioversion is recommended to prevent ventricular fibrillation in patients with a short anterograde bypass tract refractory period in whom AF occurs with a rapid ventricular response associated with hemodynamic instability. (Level of Evidence: B)

3. Intravenous procainamide or ibutilide is recommended to restore sinus rhythm in patients with WPW syndrome in whom AF occurs without hemodynamic instability in association with a wide QRS complex on the ECG (greater than or equal to 120-ms duration) or with a rapid pre-excited ventricular response. (Level of Evidence: C)

Class IIa
1. Intravenous flecainide or direct-current cardioversion is reasonable when very rapid ventricular rates occur in patients with AF involving conduction over an accessory pathway. (Level of Evidence: B)

Class IIb
1. It may be reasonable to administer intravenous quinidine, procainamide, disopyramide, ibutilide, or amiodarone to hemodynamically stable patients with AF involving conduction over an accessory pathway. (Level of Evidence: B)

Class III
1. Intravenous administration of digitalis glycosides or non dihydropyridine calcium channel antagonists is not recommended in patients with WPW syndrome who have pre-excited ventricular activation during AF.(Level of Evidence: B)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guideline Resources

 * ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter