What are the AHA/ACC/HRS treatment guidelines for atrial fibrillation (AF) in Wolff-Parkinson-White (WPW) syndrome?

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

The 2014 American Heart Association (AHA)/American College of Cardiology (ACC)/HRS guidelines management of atrial fibrillation (AF) include the following specific recommendations for WPW and preexcitation syndromes [36]

Class I (Level of evidence: C)

  • Patients with AF, WPW syndrome, and rapid ventricular response who are hemodynamically compromised should receive prompt direct-current cardioversion. (Level of evidence: C)
  • For patients with preexcited AF and rapid ventricular response who are not hemodynamically compromised, administer IV procainamide or ibutilide to restore sinus rhythm or slow the ventricular rate. (Level of evidence: C)
  • Catheter ablation of the accessory pathway in symptomatic patients with preexcited AF, especially if the accessory pathway has a short refractory period that allows rapid antegrade conduction.

Class III:(Level of evidence: B)

  • Administration of intravenous amiodarone, adenosine, digoxin (oral or intravenous), or nondihydropyridine calcium channel antagonists (oral or intravenous) in patients with WPW syndrome who have preexcited AF is potentially harmful because these drugs accelerate the ventricular rate.

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