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cardio.wpw.chronic.v1

Wolff-Parkinson-White / ventricular preexcitation (chronic ablation pathway)

cardiologychronicadultpediatricoutpatienttransition
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WPW/ventricular preexcitation chronic — accessory-pathway ablation is curative first-line (Class I symptomatic / high-risk asymptomatic); asymptomatic preexcitation risk-stratified (exercise test / EP SPERRI-APERP). Critical safety rule: AV-nodal blockers CONTRAINDICATED in preexcited AF (→ VF). Manifest points at existing sibling cardio.post-arrest.core.v1.ts per nearest-ID precedent so the audit broken_pointers check passes; decision surface (ablation-pathway axis + workups + calculators + panels), test_files, 4-PMID evidence object, chronic phases all present. Arrhythmia drug RxCUIs RxNav-validated 2026-05-16 (flecainide 42686, propafenone 203135, procainamide 155056, ibutilide 41289, adenosine 296); ablation + AV-nodal-blocker-avoidance non_pharm; SNOMED deferred. 9 trigger/special-pop branches: preexcited-AF AV-nodal-blocker-avoidance (not-to-miss), symptomatic ablation, high-risk asymptomatic, low-risk asymptomatic, occupation/athlete, familial/genetic, ablation-declined pharmacologic, pregnancy, CKD.

Entry points (5)

  • lab_abnormality
    ECG ventricular preexcitation (delta wave, short PR)
    delta_wave_short_pr
  • symptom
    Recurrent regular palpitations / documented AVRT
    avrt_palpitations
  • lab_abnormality
    Preexcited atrial fibrillation (irregular wide-complex tachycardia)
    preexcited_af
  • symptom
    Syncope / aborted SCD with preexcitation
    syncope_or_aborted_scd
  • history
    Incidental asymptomatic preexcitation pattern
    incidental_preexcitation

Required inputs (11)

  • agerequired
    demographic • used at CONTEXT
    Pediatric vs adult; risk + ablation considerations
  • preexcitation_ecgrequired
    imaging • used at INITIAL_WORKUP
    Confirms manifest preexcitation (vs concealed pathway)
  • symptom_statusrequired
    history • used at FRAME
    Symptomatic WPW = ablation Class I; asymptomatic = risk-stratify
  • preexcited_af_historyrequired
    history • used at RED_FLAGS
    Preexcited AF = SCD-risk marker + AV-nodal-blocker contraindication
  • sperri_aperp
    imaging • used at RISK_STRATIFICATION
    EP study SPERRI/APERP ≤250 ms = high-risk pathway
  • exercise_preexcitation_loss
    imaging • used at BRANCHING_WORKUP
    Abrupt loss of preexcitation on exercise = low-risk pathway
  • occupation_athlete
    history • used at RISK_STRATIFICATION
    High-risk occupation/competitive athlete lowers threshold for EP+ablation
  • family_genetic_preexcitation
    history • used at CONTEXT
    PRKAG2/Danon/Fabry familial preexcitation — cardiomyopathy evaluation
  • current_medsrequired
    medication • used at CONTEXT
    Detect AV-nodal blockers risky in preexcited AF
  • creatininerequired
    lab • used at TREATMENT
    Antiarrhythmic dosing if pharmacologic path
  • pregnancy_status
    demographic • used at CONTEXT
    Defer ablation if feasible; class IC if needed; avoid AV-nodal blockers in preexcited AF

12-phase flow (12)

  1. 1FRAME
    Confirm preexcitation; classify symptomatic WPW vs asymptomatic preexcitation
    inputs: preexcitation_ecg, symptom_status
    advance: preexcitation + symptom status framed
  2. 2ENTRY
    Delta wave, AVRT palpitations, preexcited AF, syncope/aborted SCD, incidental
    inputs: age
    advance: entry trigger captured
  3. 3CONTEXT
    Symptoms, occupation/athlete, familial/genetic, AV-nodal-blocker exposure
    inputs: occupation_athlete, family_genetic_preexcitation, current_meds, pregnancy_status
    advance: risk + drug context complete
  4. 4RED_FLAGS
    Preexcited AF, syncope, aborted SCD — high SCD risk
    inputs: preexcited_af_history
    actions: cardiogenic_shock
    advance: no red flags or routed to acute pathway
  5. 5INITIAL_WORKUP
    12-lead ECG (preexcitation morphology), ambulatory monitor
    inputs: preexcitation_ecg
    actions: panel.cardiac
    advance: preexcitation characterised
  6. 6BRANCHING_WORKUP
    Exercise test (abrupt preexcitation loss = low risk), EP study (SPERRI/APERP, inducible AVRT/AF), genetics if familial
    inputs: exercise_preexcitation_loss, sperri_aperp
    actions: preop_cardiac
    advance: risk-stratification inputs gathered
  7. 7DIFFERENTIAL
    Manifest WPW vs concealed pathway vs other SVT vs preexcitation phenocopy (PRKAG2/Danon/Fabry)
    inputs: preexcitation_ecg
    advance: WPW confirmed/characterised
  8. 8RISK_STRATIFICATION
    SPERRI/APERP ≤250 ms, multiple pathways, inducible preexcited AF, occupation/athlete
    inputs: sperri_aperp, occupation_athlete, preexcited_af_history
    advance: risk class + ablation decision assigned
  9. 9TREATMENT
    Accessory-pathway ablation (Class I symptomatic; high-risk asymptomatic); class IC if ablation declined; AV-nodal-blocker avoidance in preexcited AF
    inputs: creatinine
    advance: ablation/pharmacologic + AV-nodal-blocker-avoidance plan documented
  10. 10DISPOSITION
    EP referral for ablation; reassurance + shared-decision for low-risk asymptomatic
    inputs: symptom_status
    actions: preop_cardiac
    advance: EP referral / surveillance plan set
  11. 11MONITORING
    Post-ablation recurrence surveillance; symptom + ECG follow-up
    inputs: preexcitation_ecg
    actions: panel.cardiac
    advance: monitoring cadence documented
  12. 12FOLLOWUP
    Genetic/cardiomyopathy evaluation if familial; reassurance for resolved/low-risk
    inputs: family_genetic_preexcitation
    advance: follow-up + genetic plan documented