Nine Indications of Ablation of Accessory Pathway - 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.

Visit ECG Library Here >>

Keywords:

WPW Syndrome 

WPW ECG

Delta Wave on ECG

Accessory Pathway Ablation