Atrial fibrillation Wolff-Parkinson-White preexcitation syndromes
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Sinus rhythm  |
Atrial fibrillation  | |
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| ICD-10 | I48 |
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| ICD-9 | 427.31 |
| DiseasesDB | 1065 |
| MedlinePlus | 000184 |
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Atrial Fibrillation Microchapters | |
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Cardioversion | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.
Overview
The incidence of sudden cardiac death is between 0% and 0.6% in patients with Wolff-Parkinson-White syndrome,[1][2][3][4] particularly those with short antegrade bypass tract refractory periods (less than 250 ms) and short R-R intervals during pre-excited AF (180 plus or minus 29 ms).[5][6] In hemodynamically stable patients, intravenous procainamide may be administered to convert pre-exited AF to sinus rhythm. AV nodal blocking agents such as digoxin, diltiazem, or verapamil are contra-indicated as they increase AV-node refractoriness which could encourage preferential conduction over the accessory pathway. AF associated with a rapid tachycardia due to an accessory pathway may be treated with flecainide that has shown to slower the ventricular rate by prolonging the shortest pre-excited cycle length during AF and hence terminate AF.[7][8][9][10]
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)[11]
Wolff-Parkinson-White (WPW) Preexcitation Syndromes (DO NOT EDIT) [11]
| Class I |
| "1. Catheter ablation of the accessory pathway is recommended in symptomatic patients with AF who have WPW syndrome, 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 AF 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 WPW syndrome in whom AF 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 WPW syndrome who have preexcited ventricular activation during AF. (Level of Evidence: B)" |
| Class IIa |
| "1. Intravenous flecainide or direct-current cardioversion is reasonable when very rapid ventricular rates occur in patients with AF 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 AF involving conduction over an accessory pathway. (Level of Evidence: B)" |
Related Chapters
Sources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [13]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [14]
References
- ↑ Munger TM, Packer DL, Hammill SC, Feldman BJ, Bailey KR, Ballard DJ et al. (1993) A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 87 (3):866-73. PMID: 8443907
- ↑ Leitch JW, Klein GJ, Yee R, Murdock C (1990) Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern. Circulation 82 (5):1718-23. PMID: 2225373
- ↑ Soria R, Guize L, Chretien JM, Le Heuzey JY, Lavergne T, Desnos M et al. (1989) [The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population.] Arch Mal Coeur Vaiss 82 (3):331-6. PMID: 2502088
- ↑ Flensted-Jensen E (1969) Wolff-Parkinson-White syndrome. A long-term follow-up of 47 cases. Acta Med Scand 186 (1-2):65-74. PMID: 5807647
- ↑ Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ (1979) Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 301 (20):1080-5. DOI:10.1056/NEJM197911153012003 PMID: 492252
- ↑ Zardini M, Yee R, Thakur RK, Klein GJ (1994) Risk of sudden arrhythmic death in the Wolff-Parkinson-White syndrome: current perspectives. Pacing Clin Electrophysiol 17 (5 Pt 1):966-75. PMID: 7517532
- ↑ Kappenberger LJ, Fromer MA, Shenasa M, Gloor HO (1985) Evaluation of flecainide acetate in rapid atrial fibrillation complicating Wolff-Parkinson-White syndrome. Clin Cardiol 8 (6):321-6. PMID: 4006340
- ↑ Kim SS, Smith P, Ruffy R (1988) Treatment of atrial tachyarrhythmias and preexcitation syndrome with flecainide acetate. Am J Cardiol 62 (6):29D-34D. PMID: 3136632
- ↑ Crijns HJ, den Heijer P, van Wijk LM, Lie KI (1988) Successful use of flecainide in atrial fibrillation with rapid ventricular rate in the Wolff-Parkinson-White syndrome. Am Heart J 115 (6):1317-21. PMID: 3132032
- ↑ O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 14 (11 Pt 2):2028-34. PMID: 1721219
- ↑ 11.0 11.1 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 developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
- ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines 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 European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ 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
- ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199
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