The Living Guidelines: Patients with Wolff Parkinson White syndrome (WPW): Suggest Revisions to the CLASS I Guidelines

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Class I Guidelines

 * 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)