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10.6. Wolff-Parkinson-White (WPW) and Pre-Excitation
Syndromes
COR LOE
Recommendations
1 B-NR 1. Patients with AF with rapid anterograde conduction (pre-
excited AF), and hemodynamic instability should be treated
with electrical cardioversion.
1 B-NR 2. For patients with AF with rapid anterograde conduction
(pre-excited AF), catheter ablation of accessory pathways
(APs) is recommended.
1 C-LD 3. In patients with AF with rapid anterograde conduction (pre-
excited AF) and hemodynamic stability, pharmacological
cardioversion with intravenous ibutilide or intravenous
procainamide is recommended as an alternative to elective
cardioversion.
3: Harm B-NR 4. For patients with AF with anterograde accessory pathway
conduction (pre-excited AF), pharmacological agents
that block AV nodal conduction (verapamil, diltiazem,
amiodarone, digoxin, adenosine, or beta blockers)
are contraindicated due to risk of precipitating VF or
hemodynamic deterioration.
10.5. AF and VHD
