Which patients with Wolff-Parkinson-White (WPW) syndrome have a long accessory pathway (AP) refractory period?

Updated: Jan 08, 2017
  • Author: Christopher R Ellis, MD, FACC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Answer

Patients who have intermittent preexcitation or those who lose ECG evidence of preexcitation abruptly with exercise or when injected intravenously with procainamide generally have a long AP refractory period. These patients are thought to have a low risk of developing a rapid ventricular rate should atrial flutter or AF develop (see the image below).

Preexcited atrial fibrillation. Preexcited atrial fibrillation.

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