Wolff-Parkinson-White syndrome consensus statement: Difference between revisions

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{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{Sara.Zand}} {{CZ}}; [[User:Kashish Goel|Kashish Goel, M.D.]]
==PACES/HRS Expert Consensus - Recommendations for Risk Stratification (DO NOT EDIT)==
<ref name="pmid22579340">{{cite journal |author=Cohen MI, Triedman JK, Cannon BC, ''et al.'' |title=PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern: Developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS) |journal=Heart Rhythm |volume= |issue= |pages= |year=2012 |month=May |pmid=22579340 |doi=10.1016/j.hrthm.2012.03.050 |url=}}</ref>
 
 
{{cquote|
===[[American College of Chest Physicians#Classes of Recommendations|Class I]]===
 
1. An exercise stress test, when the child is old enough to comply, is a reasonable component of the evaluation if the ambulatory ECG exhibits persistent preexcitation (Class IIA, Levels of Evidence B/C). In patients with clear and abrupt loss of preexcitation at physiological heart rates, the accessory pathway properties pose a lower risk of sudden death. In children with subtle preexcitation the ECG and exercise test may be difficult to interpret.


2. Utilization of invasive risk stratification (transesophageal or intracardiac) to assess the shortest preexcited R-R interval in atrial fibrillation is reasonable in individuals whose noninvasive testing does not demonstrate clear and abrupt loss of preexcitation (Class IIA, Levels of Evidence B/C).2


3. Young patients with a SPERRI  250 ms in atrial fibrillation are at increased risk for SCD. It is reasonable to consider catheter ablation in this group, taking into account the procedural risk factors based on the anatomical location of the pathway (Class IIA, Levels of Evidence B/C).
== Recommendations for Management of Asymptomatic Patients With Asymptomatic pre-excitation ==
* '''2015 ACC-AHA Guideline'''<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>


# Young patients with a SPERRI  250 ms in atrial fibrillation are at lower risk for SCD, and it is reasonable to defer ablation (Class IIA, Level of Evidence C). Ablation may be considered in these patients at the time of diagnostic study if the location of the pathway and/or patient characteristics do not suggest that ablation may incur an increased risk of adverse events, such as AV block or coronary artery injury (Class IIB, Level of Evidence C)
{| class="wikitable"
|-
!  Class of Recommendation(COR) !! Recommendations
|-
|    1    || In asymptomatic patients with pre-excitation, the findings of abrupt loss of conduction over
manifest pathway during [[exercise testing]] in [[sinus rhythm]] or
intermittent loss of-excitation during [[ECG]] or ambulatory monitoring is useful to identify patients at low risk of rapid conduction over the pathway
|-
| 2a || An [[EP study]] is reasonable in asymptomatic patients with pre-excitation to risk-stratify for
arrhythmic events
|-
| 2a || [[Catheter ablation]] of the [[accessory pathway]] is reasonable in asymptomatic [[patients]] with pre-
excitation if an [[EP study]] identifies a high risk of [[arrhythmic]] events, including rapidly conducting
pre-excited [[AF]]
|-
| 2a || [[Catheter ablation]] of the accessory pathway is reasonable in asymptomatic patients if the presence of
pre-excitation precludes specific employment(such as with [[pilots]])
|-
| 2a || Observation,without further evaluation or treatment,is reasonable in asymptomatic patients
with pre-excitation
|}


# Young patients deemed to be at low risk might subsequently develop cardiovascular symptoms such as syncope or palpitations. These patients should then be considered symptomatic and may be eligible for catheter ablation procedures regardless of the prior assessment.


# Asymptomatic patients with a WPW ECG pattern and structural heart disease are at risk for both atrial tachycardia and AV reciprocating tachycardia, which may result in unfavorable hemodynamics. Ablation may be considered regardless of the anterograde characteristics of the accessory pathway (Class IIB, Level of Evidence C).
== Recommendations for Management of Symptomatic Patients With Manifest Accessory Pathways ==
* '''2015 ACC-AHA Guideline'''<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 patients with a WPW ECG pattern and ventricular dysfunction secondary to dyssynchronous contractions may be considered for ablation, regardless of anterograde characteristics of the bypass tract (Class IIB, Level of Evidence C).
{| class="wikitable"
|-
! Class of Recommendation !! Recommendations
|-
| 1 || In symptomatic patients with [[pre-excitation]], the findings of abrupt loss of conduction over the
pathway during [[exercise testing]] in [[sinus rhythm]] or intermittent loss
of [[pre-excitation]] during [[ECG]] or ambulatory monitoring are useful for
identifying patients at lower risk of developing rapid conduction over the[[ pathway]]
|-
| 1 || An EP study is useful in symptomatic patients with [[pre-excitation]] to risk-stratify for
life-threatening [[arrhythmic]] events
|}


# Asymptomatic patients with a WPW ECG pattern may be prescribed ADHD medications. This recommendation follows the American Heart Association Guidelines, which state that ADHD medications may be used in this setting after cardiac evaluation and with intermittent monitoring and supervision of a pediatric cardiologist.<ref name="pmid18427125">{{cite journal |author=Vetter VL, Elia J, Erickson C, ''et al.'' |title=Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing |journal=Circulation |volume=117 |issue=18 |pages=2407–23 |year=2008 |month=May |pmid=18427125 |doi=10.1161/CIRCULATIONAHA.107.189473 |url=}}</ref>
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 06:24, 15 September 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Kashish Goel, M.D.


Recommendations for Management of Asymptomatic Patients With Asymptomatic pre-excitation

  • 2015 ACC-AHA Guideline[1]
Class of Recommendation(COR) Recommendations
1 In asymptomatic patients with pre-excitation, the findings of abrupt loss of conduction over

manifest pathway during exercise testing in sinus rhythm or intermittent loss of-excitation during ECG or ambulatory monitoring is useful to identify patients at low risk of rapid conduction over the pathway

2a An EP study is reasonable in asymptomatic patients with pre-excitation to risk-stratify for

arrhythmic events

2a Catheter ablation of the accessory pathway is reasonable in asymptomatic patients with pre-

excitation if an EP study identifies a high risk of arrhythmic events, including rapidly conducting pre-excited AF

2a Catheter ablation of the accessory pathway is reasonable in asymptomatic patients if the presence of

pre-excitation precludes specific employment(such as with pilots)

2a Observation,without further evaluation or treatment,is reasonable in asymptomatic patients

with pre-excitation


Recommendations for Management of Symptomatic Patients With Manifest Accessory Pathways

  • 2015 ACC-AHA Guideline[1]
Class of Recommendation Recommendations
1 In symptomatic patients with pre-excitation, the findings of abrupt loss of conduction over the

pathway during exercise testing in sinus rhythm or intermittent loss of pre-excitation during ECG or ambulatory monitoring are useful for identifying patients at lower risk of developing rapid conduction over thepathway

1 An EP study is useful in symptomatic patients with pre-excitation to risk-stratify for

life-threatening arrhythmic events

References

  1. ↑ 1.0 1.1 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.

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