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Nine Indications of Ablation of Accessory Pathway - WPW Syndrome

Indications to ablate wpw Syndrome

ECG Showing Intermittent Delta Wave

Above ECG is showing delta wave in some of the QRS complexes, others being normal. To decide further management we take into account various factors.

When to Ablate for Pre-excitation / Delta Wave or WPW ECG Pattern or Syndrome:


1. Symptomatic AVRT

2. Pre excited AF

3. Asymptomatic with LV Dysfunction due to electrical dyssnchrony 

4. Asymptomatic with High Risk Profession i.e Pilot, Professional Athlete

5. Asymptomatic with High Risk features i.e

SPERRI <250 msec (Shortest Pre-excitated RR Interbal)

AP ERP <250 msec

Multiple APs

AP mediated Tachycardia 


Low Risk Features:

Intermittent Pre-excitation 

Delta Wave that disappears on ETT

Sudden loss of Delta wave on holter monitoring


Ablation is the standard first line treatment for WPW Syndrome in above enlisted scenarios but sometimes it may be delayed or not feasible then following medications can be considered:

Structurally Normal Heart:

Flecainide, and propafenone 


Abnormal Heart:

Dofetilide or sotalol are reasonable options in patients with structural heart disease


AV nodal blocking agents, including beta-blockers, verapamil, diltiazem, or digoxin, are contraindicated but may be reasonable in special situations like orthodromic AVRT or WPW pattern on ECG after discussing with cardiac electrophysiologist.


Thanks 😊 

If you have any query, Feel free to ask in comment section below.


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Keywords:

WPW Syndrome 

WPW ECG

Delta Wave on ECG

Accessory Pathway Ablation 


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Comments

  1. AnonymousJanuary 25, 2025 at 4:16 PM

    I was just reading ESC SVT guidelines from 2019. These guidelines don't mention sotalol and dofetilide in the treatment of wpw patients. Personally I would stay away from sotalol because it has AV blocking properties. Betablokers and CCB generally should not be used among patients with preexitation in ECG but can be used when someone has know accessory pathway and AVRT but without wpw features on ECG - when the pathway conducts only backwards in case of AF patient is safe

    ReplyDelete
  2. Dr. UsmanJanuary 31, 2025 at 9:59 AM

    Yes Exactly 👍 Thanks Alot for your input

    ReplyDelete

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