37. Initiation of long term rhythm control therapy in symptomatic
patients with atrial fibrillation
38.
39.
40. Wolff–Parkinson–White syndrome
Patients with pre-excitation and AF are at risk of rapid conduction across the accessory
pathway, resulting in a fast ventricular rate, possible ventricular fibrillation, and
sudden death. In AF patients with evidence of an antegrade accessory pathway,
catheter ablation of the pathway is recommended. This procedure is safe and effective
and may be considered as a prophylactic treatment strategy. In AF patients surviving a
sudden death event with evidence of an accessory pathway, urgent catheter ablation
of the pathway is recommended. A documented short pre-excited RR interval ( < 250
ms) during spontaneous or induced AF is one of the risk markers for sudden death in
Wolff–Parkinson–White syndrome (WPW) syndrome, in addition to a history of
symptomatic tachycardia, the presence of multiple accessory pathways, and Ebstein’s
anomaly. Intravenous procainamide, propafenone, or ajmaline can be used to acutely
slow ventricular rate, whereas digoxin, verapamil, and diltiazem are contraindicated.
Intravenous amiodarone should be used with caution, as there are case reports of
accelerated ventricular rhythms and ventricular fibrillation in patients with preexcited
AF receiving intravenous amiodarone infusion.