Asymptomatic Pre-Excitation
Table 13. Asymptomatic Patients With Pre-Excitation
COR
LOE
a
Recommendations
I
B-NR
SR
In asymptomatic patients with pre-excitation, the findings of
abrupt loss of conduction over a manifest pathway during exercise
testing in sinus rhythm (LOE: B-NR)
SR
or intermittent loss of
pre-excitation during ECG or ambulatory monitoring (LOE:
C-LD)
SR
are useful to identify patients at low risk of rapid
conduction over the pathway.
C-LD
SR
IIa
B-NR
SR
An EP study is reasonable in asymptomatic patients with pre-
excitation to risk-stratify for arrhythmic events.
IIa
B-NR
SR
Catheter ablation of the accessory pathway is reasonable in
asymptomatic patients with pre-excitation if an EP study
identifies a high risk of arrhythmic events, including rapidly
conducting pre-excited AF.
IIa
B-NR
SR
Catheter ablation of the accessory pathway is reasonable in
asymptomatic patients if the presence of pre-excitation precludes
specific employment (such as with pilots).
IIa
B-NR
SR
Observation, without further evaluation or treatment, is
reasonable in asymptomatic patients with pre-excitation.
a
ese recommendations have been designated with the notation SR to emphasize the rigor
of support from the Evidence Review Committee's systematic review.
Table 14. Risk Stratification of Symptomatic Patients With
Manifest Accessory Pathways
COR
LOE Recommendations
I B-NR In symptomatic patients with pre-excitation, the findings of
abrupt loss of conduction over the pathway during exercise
testing in sinus rhythm (LOE: B-NR) or intermittent loss of pre-
excitation during ECG or ambulatory monitoring (LOE: C-LD)
are useful to identify patients at low risk of developing rapid
conduction over the pathway.
C-LD
I B-NR An EP study is useful in symptomatic patients with pre-excitation
to risk-stratify for life-threatening arrhythmic events.
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