From the Guidelines
The definitive treatment for Wolff-Parkinson-White syndrome is catheter ablation, which offers a curative approach by eliminating the accessory pathway responsible for the condition. This procedure has a high success rate and is recommended as first-line therapy for symptomatic patients 1.
Key Considerations
- For acute management of tachycardia episodes, intravenous procainamide or ibutilide can be used to restore sinus rhythm or slow the ventricular rate in patients who are not hemodynamically compromised 1.
- In patients with WPW and atrial fibrillation with rapid ventricular response, immediate electrical cardioversion is indicated if hemodynamically unstable; if stable, procainamide can be administered 1.
- Beta-blockers or calcium channel blockers should be avoided as monotherapy in WPW as they may paradoxically increase ventricular response during atrial fibrillation by preferentially blocking the AV node 1.
Long-term Management
- Long-term management should include regular cardiac follow-up, and patients should be educated about symptoms requiring urgent medical attention.
- The underlying mechanism of WPW involves an accessory electrical pathway (Bundle of Kent) that bypasses the AV node, creating a circuit for reentrant tachycardias and allowing rapid conduction during atrial arrhythmias.
Treatment Options
- Catheter ablation is the preferred treatment for symptomatic patients with WPW syndrome, especially those with a short refractory period that allows rapid antegrade conduction 1.
- Antiarrhythmic medications, such as class IC agents or class III agents, can be used in patients awaiting ablation or those who decline the procedure 1.
From the FDA Drug Label
Propafenone has little or no effect on the atrial functional refractory period, but AV nodal functional and effective refractory periods are prolonged. In patients with Wolff-Parkinson-White (WPW) syndrome, propafenone reduces conduction and increases the effective refractory period of the accessory pathway in both directions
The treatment for Wolff-Parkinson-White (WPW) Syndrome is propafenone, which reduces conduction and increases the effective refractory period of the accessory pathway in both directions 2.
- Key effects:
- Reduces conduction
- Increases the effective refractory period of the accessory pathway
- Prolongs AV nodal functional and effective refractory periods Note that the use of propafenone should be guided by its potential effects on cardiac function, particularly in patients with pre-existing heart conditions.
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 3
- Long-term therapy includes:
Role of Catheter Ablation
Catheter ablation is considered the most effective means of achieving the goal of reducing symptom burden and attenuating the risk of pre-excited atrial fibrillation in WPW syndrome 5, 4.
- It involves the use of radiofrequency catheter ablation to prevent further recurrence of tachycardias associated with WPW syndrome 3
- This procedure has proven to be safe, cost-effective, and well-tolerated 4
Medication Therapy
Medications are 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 5.
- Medications used include:
Surgical Ablation
Surgical ablation of a bypass tract in a symptomatic patient is considered when catheter ablation is not feasible 4.
- Open chest surgical ablation of a bypass tract was first reported in 1968
- The original endocardial surgical techniques for localizing and dividing APs were refined, and an alternative epicardial approach has been developed 4