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WPW / Pre-excitation
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Arrhythmias & DevicesIntermediateIn progressOne-page PDF
ECG recognition, risk features, AF with WPW warning, medication cautions, and EP referral.
Last reviewed
Pending initial clinical review
Sources / guidelines to verify
- 2015 ACC/AHA/HRS SVT Guideline (pre-excitation section)
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- An accessory pathway causes pre-excitation and a risk of SVT (AVRT).
- The danger: rapid conduction of atrial fibrillation down the pathway → VF.
2
Key diagnostic clues
- ECG in sinus: short PR + delta wave + wide QRS.
- AVRT = regular SVT; AF with WPW = wide, irregular, and very fast.
3
Initial workup
- 12-lead ECG, echo; EP study for risk stratification in high-risk features, athletes, or certain occupations.
4
Management framework
- Stable AVRT: vagal maneuvers/adenosine.
- Definitive treatment is catheter ablation of the pathway (high success).
5
Red flags / escalate now
- AF with pre-excitation → AVOID AV-nodal blockers (adenosine, beta-blockers, CCBs, digoxin) → procainamide or cardioversion.
- Syncope or a very short pre-excited RR interval → urgent EP.
6
Follow-up / monitoring
- EP referral; post-ablation follow-up.
7
Clinic pearls
- AF + WPW is the danger scenario — no AV-nodal blockers.
- Ablation is curative; refer symptomatic and high-risk asymptomatic patients.
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