What is the treatment for Wolff-Parkinson-White (WPW) syndrome?

From the Guidelines

The treatment for Wolff-Parkinson-White (WPW) syndrome involves catheter ablation of the accessory pathway, which is recommended in symptomatic patients, particularly those with syncope due to rapid heart rate or those with a short bypass tract refractory period 1.

Treatment Options

• Catheter ablation: This is a recommended treatment for symptomatic patients with WPW syndrome, especially those with a short refractory period that allows rapid antegrade conduction 1.
• Direct-current cardioversion: This is recommended for patients with WPW syndrome and rapid ventricular response who are hemodynamically compromised 1.
• Intravenous procainamide or ibutilide: These medications are recommended to restore sinus rhythm or slow the ventricular rate in patients with pre-excited AF and rapid ventricular response who are not hemodynamically compromised 1.

Key Considerations

• Hemodynamic instability: Patients with WPW syndrome and rapid ventricular response who are hemodynamically unstable should undergo immediate direct-current cardioversion to prevent ventricular fibrillation 1.
• Short bypass tract refractory period: Patients with a short bypass tract refractory period are at higher risk of ventricular fibrillation and should be considered for catheter ablation or immediate direct-current cardioversion if they develop AF with a rapid ventricular response 1.

From the Research

Treatment Options for Wolff-Parkinson-White (WPW) Syndrome

The treatment for WPW syndrome can be categorized into short-term and long-term therapies.

• Short-term therapy includes:
  • Vagal maneuvers
  • Atrioventricular nodal blocking agents
  • Direct current cardioversion
  • Medications such as adenosine to terminate paroxysms of arrhythmia associated with the accessory pathway 2, 3
• Long-term therapy includes:
  • Antiarrhythmic therapy
  • Surgical or catheter ablation

Catheter Ablation

Catheter ablation has been proven as a very effective and safe therapy for patients with symptomatic WPW syndrome 4, 3, 5.

• The efficacy of catheter ablation therapy is about 90% to 95% 5
• It is associated with a low morbidity rate 5
• Radiofrequency catheter ablation remains the first-line therapy for patients with symptomatic WPW syndrome 4, 3

Medication Therapy

Medication is often employed in the acute setting to terminate paroxysms of arrhythmia associated with the accessory pathway and reduce the subsequent burden of symptoms until ablation can be performed 6.

• Medications that prolong AP refractory periods (flecainide, propafenone, and amiodarone) prevent rapid AP anterograde conduction (from atria to ventricles) in atrial tachycardias such as atrial fibrillation or flutter 3
• Class IA or IC antiarrhythmic agents are used to slow AP conduction either with or without AV nodal blocking agents 3

Surgical Ablation

Surgical ablation has become relegated to those cases where symptoms are intolerable and RF ablation is not feasible 3.

• Open chest surgical ablation of a bypass tract in a symptomatic patient was first reported in 1968 3
• Reported mortality rates in experienced hands were 0% to 1.5% in large series for patients without additional cardiac abnormalities 3