Atrial fibrillation Wolff-Parkinson-White preexcitation syndromes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anahita Deylamsalehi, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S.

Overview

Atrial fibrillation in Wolff-Parkinson-White preexcitation syndromes

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[18]

Wolff-Parkinson-White and Pre-Excitation Syndromes

Class I
"1. Prompt direct-current cardioversion is recommended for patients with atrial fibrillation, Wolff-Parkinson-White syndrome (WPW), and rapid ventricular response who are hemodynamically compromised. (Level of Evidence: C)"
"2. Intravenous procainamide or ibutilide to restore sinus rhythm or slow the ventricular rate is recommended for patients with pre-excited atrial fibrillation and rapid ventricular response who are not hemodynamically compromised. (Level of Evidence: C)"
"3. Catheter ablation of the accessory pathway is recommended in symptomatic patients with pre-excited atrial fibrillation, especially if the accessory pathway has a short refractory period that allows rapid antegrade conduction. (Level of Evidence: C)"
Class III: No Benefit
"1. Administration of intravenous amiodarone, adenosine, digoxin (oral or intravenous), or nondihydropyridine calcium antagonists (oral or intravenous) in patients with Wolff-Parkinson-White syndrome (WPW) who have pre-excited atrial fibrillation is potentially harmful as these treatments accelerate the ventricular rate. (Level of Evidence: B)"

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[19]

Wolff-Parkinson-White (WPW) Preexcitation Syndromes (DO NOT EDIT) [19]

Class I
"1. Catheter ablation of the accessory pathway is recommended in symptomatic patients with atrial fibrillation who have Wolff-Parkinson-White syndrome (WPW), particularly those with syncope due to rapid heart rate or those with a short bypass tract refractory period. (Level of Evidence: B)"
"2. Immediate direct-current cardioversion is recommended to prevent ventricular fibrillation in patients with a short anterograde bypass tract refractory period in whom atrial fibrillation occurs with a rapid ventricular response associated with hemodynamic instability. (Level of Evidence: B)"
"3. Intravenous procainamide or ibutilide is recommended to restore sinus rhythm in patients with Wolff-Parkinson-White syndrome (WPW) in whom atrial fibrillation occurs without hemodynamic instability in association with a wide QRS complex on the ECG (greater than or equal to 120-ms duration) or with a rapid pre-excited ventricular response. (Level of Evidence: C)"
Class III (Harm)
"1. Intravenous administration of digitalis glycosides or nondihydropyridine calcium channel antagonists is not recommended in patients with Wolff-Parkinson-White syndrome (WPW) who have preexcited ventricular activation during atrial fibrillation. (Level of Evidence: B)"
Class IIa
"1. Intravenous flecainide or direct-current cardioversion is reasonable when very rapid ventricular rates occur in patients with atrial fibrillation involving conduction over an accessory pathway. (Level of Evidence: B)"
Class IIb
"1. It may be reasonable to administer intravenous quinidine, procainamide, disopyramide, ibutilide, or amiodarone to hemodynamically stable patients with atrial fibrillation involving conduction over an accessory pathway. (Level of Evidence: B)"

Sources

References

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  18. January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
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  21. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
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CME Category::Cardiology