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Patient handout

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

PRODUCTION

1. Your condition

This handout is for wolff-parkinson-white / ventricular preexcitation (chronic ablation pathway). Your care team identified this based on: ecg ventricular preexcitation (delta wave, short pr).

Other reasons your team may use this plan: recurrent regular palpitations / documented avrt; preexcited atrial fibrillation (irregular wide-complex tachycardia); syncope / aborted scd with preexcitation.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

MedicationStarting doseHowWhenWhat it does
AVOID AV-nodal blockers (digoxin, verapamil, diltiazem, IV beta-blockers, adenosine) in preexcited AF———AV-nodal blockade in preexcited AF accelerates accessory-pathway conduction → VF — absolute avoidance (2019 ESC SVT)

Plan: WPW ablation pathway + safe pharmacologic alternative (2015 ACC/AHA/HRS SVT; 2019 ESC SVT)

3. When to call your provider

Contact your care team if any of the following happen:

  • Preexcited AF / syncope / aborted SCD → urgent ablation; acute episode → ED (no AV-nodal blockers) — 2019 ESC SVT
  • Recurrent preexcitation post-ablation → repeat EP/ablation — 2015 ACC/AHA/HRS SVT

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • Preexcited AF (irregular wide-complex) — AV-nodal blockers (digoxin/verapamil/diltiazem/IV BB/adenosine) CONTRAINDICATED (→ VF); urgent ablation; acute unstable → synchronized cardioversion — 2019 ESC SVT(life-threatening)
  • Symptomatic WPW (AVRT or preexcited AF) — catheter ablation Class I (curative) — 2015 ACC/AHA/HRS SVT
  • Asymptomatic preexcitation with SPERRI/APERP ≤250 ms, multiple pathways, or inducible preexcited AF — high-risk → ablation — 2019 ESC SVT
  • Pregnancy with WPW — defer ablation if feasible; AVOID AV-nodal blockers in preexcited AF; class IC if drug needed; cardio-obstetric — ESC 2018 Pregnancy; 2019 ESC SVT

5. Follow-up

Genetic/cardiomyopathy evaluation if familial; reassurance for resolved/low-risk

6. Sources

Guideline: 2015 ACC/AHA/HRS SVT Guideline + 2019 ESC SVT Guideline; 2017 AHA/ACC/HRS + 2022 ESC VA (SCD context)

  1. pubmed.ncbi.nlm.nih.gov/26399663
  2. pubmed.ncbi.nlm.nih.gov/31504425
  3. pubmed.ncbi.nlm.nih.gov/29084731