Wolff-Parkinson-White syndrome catheter ablation: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Wolff-Parkinson-White syndrome}} | {{Wolff-Parkinson-White syndrome}} | ||
{{CMG}}; {{AE}} {{Rim}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{Rim}} | ||
==Overview== | ==Overview== | ||
[[Catheter ablation]] is indicated in the long term management of patients with Wolff-Parkinson-White (WPW) syndrome.<ref name=" | [[Catheter ablation]] is indicated in the long term management of patients with Wolff-Parkinson-White (WPW) syndrome. | ||
The indications of catheter ablation in [[WPW syndrome]] are as follows:<ref name="PageJoglar2016">{{cite journal|last1=Page|first1=Richard L.|last2=Joglar|first2=José A.|last3=Caldwell|first3=Mary A.|last4=Calkins|first4=Hugh|last5=Conti|first5=Jamie B.|last6=Deal|first6=Barbara J.|last7=Estes III|first7=N.A. Mark|last8=Field|first8=Michael E.|last9=Goldberger|first9=Zachary D.|last10=Hammill|first10=Stephen C.|last11=Indik|first11=Julia H.|last12=Lindsay|first12=Bruce D.|last13=Olshansky|first13=Brian|last14=Russo|first14=Andrea M.|last15=Shen|first15=Win-Kuang|last16=Tracy|first16=Cynthia M.|last17=Al-Khatib|first17=Sana M.|title=2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia|journal=Heart Rhythm|volume=13|issue=4|year=2016|pages=e136–e221|issn=15475271|doi=10.1016/j.hrthm.2015.09.019}}</ref> | |||
* Asymptomatic preexcited [[AF]] with rapid conduction over the [[accessory pathway]] in electrophysiology study | |||
* Asymptomatic preexcitation in specific jobs such as airline pilots, athletes involved in moderate or high level competitive sports | |||
* Presence of [[AVRT]] and preexcited [[AF]] | |||
* Presence of atriofascicular ( mahain) [[accessory pathway]] | |||
<br> | |||
== Approach to [[AVRT]]== | |||
{{Family tree/start}} | |||
{{Family tree| | | | | | A01 | | | |A01= [[Orthodromic AVRT]]}} | |||
{{Family tree| | | | | | |!| | | | | }} | |||
{{Family tree| | | | | | B01 | | | |B01= [[Pre-excitation]] on resting [[ECG]]}} | |||
{{Family tree| | | |,|-|-|^|-|-|-|-|-|-|-|.| | |}} | |||
{{Family tree| | | C01 | | | | | | | | | |C02| |C01= Yes| C02= NO}} | |||
{{Family tree| | | |!| | | | | | | | | | |!| | | | | | | | | |}} | |||
{{Family tree| | |D1 | | | | | | | | | | D2| | | | | | | | |D2= [[Ablation]] candidate, [[patient]] prefers [[ablation]] |D1=[[Ablation]] candidate, willing to undergo [[ablation]] |}} | |||
{{Family tree| | |,|^|-|-|-|-|.| | | | |,|^|-|-|-|-|-|-|-|-|-|-|.|}} | |||
{{Family tree| | |E1 | | | |E2 | | | F1| | | | | | | | |F2 | | | |F1= Yes | E2=Yes|E1=N0 |F2=NO|}} | |||
{{Family tree| |,|^|-|-|.| | | | |!| | | |!| | | | | | | | | | |!| | | | | | }} | |||
{{Family tree| |G1 | | G2| | | H1| |I1 | | | |,|-|-|-|-|+|-|-|-|.| | | |I1= [[Catheter ablation]] (class 1) | H1=[[Catheter ablation]] (class 1)|G2=[[Amiodarone]], [[betablocker]], [[diltiazem]], [[dofetilide]], [[sotalol]], [[verapamil]] (class 2b) |G1=[[Flecainide]] or [[propafenone]] in the absent of [[structural heart disease]] (class 2a) |}} | |||
{{Family tree| |!| | | |!| | | | | | | | | | | | |J1 | | |J2 | | J3| | | | | | | | | J1=[[Betablocker]], [[diltiazem]], [[verapamil]] (class1)|J2=[[Flecainide]], [[propafenone]] in the absent of [[structural heart disease]] (class 2a)|J3= [[Amiodarone]], [[digoxin]], [[dofetilide]], [[sotalol]] (class 2b) }} | |||
{{Family tree| |V1 | |V1 | | | | | | | | | | | |!| | | |!| | | |!| | | | | | | | V1=If ineffective, consider [[ablation]]|}} | |||
{{Family tree| | | | | | | | | | | | | | | | | | | V1| |V1 | |V1 | | | | | | | | | V1=If ineffective, consider [[ablation]] | | | | | | | | | |}} | |||
{{Family tree/end}} | |||
==References== | ==References== | ||
Latest revision as of 10:47, 5 August 2022
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Wolff-Parkinson-White syndrome Microchapters |
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Differentiating Wolff-Parkinson-White syndrome from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Wolff-Parkinson-White syndrome catheter ablation On the Web |
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Wolff-Parkinson-White syndrome catheter ablation in the news |
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Risk calculators and risk factors for Wolff-Parkinson-White syndrome catheter ablation |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Rim Halaby, M.D. [3]
Overview
Catheter ablation is indicated in the long term management of patients with Wolff-Parkinson-White (WPW) syndrome. The indications of catheter ablation in WPW syndrome are as follows:[1]
- Asymptomatic preexcited AF with rapid conduction over the accessory pathway in electrophysiology study
- Asymptomatic preexcitation in specific jobs such as airline pilots, athletes involved in moderate or high level competitive sports
- Presence of AVRT and preexcited AF
- Presence of atriofascicular ( mahain) accessory pathway
Approach to AVRT
| Orthodromic AVRT | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pre-excitation on resting ECG | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | NO | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ablation candidate, willing to undergo ablation | Ablation candidate, patient prefers ablation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| N0 | Yes | Yes | NO | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Flecainide or propafenone in the absent of structural heart disease (class 2a) | Amiodarone, betablocker, diltiazem, dofetilide, sotalol, verapamil (class 2b) | Catheter ablation (class 1) | Catheter ablation (class 1) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Betablocker, diltiazem, verapamil (class1) | Flecainide, propafenone in the absent of structural heart disease (class 2a) | Amiodarone, digoxin, dofetilide, sotalol (class 2b) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If ineffective, consider ablation | If ineffective, consider ablation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If ineffective, consider ablation | If ineffective, consider ablation | If ineffective, consider ablation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Page, Richard L.; Joglar, José A.; Caldwell, Mary A.; Calkins, Hugh; Conti, Jamie B.; Deal, Barbara J.; Estes III, N.A. Mark; Field, Michael E.; Goldberger, Zachary D.; Hammill, Stephen C.; Indik, Julia H.; Lindsay, Bruce D.; Olshansky, Brian; Russo, Andrea M.; Shen, Win-Kuang; Tracy, Cynthia M.; Al-Khatib, Sana M. (2016). "2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia". Heart Rhythm. 13 (4): e136–e221. doi:10.1016/j.hrthm.2015.09.019. ISSN 1547-5271.