Recommendations for Long-Term Therapy of Accessory Pathway-Mediated Arrhythmias
| Arrhythmia | Recommendation | Classification | Level of Evidence | References |
|---|---|---|---|---|
| WPW syndrome (pre-excitation and symptomatic arrhythmias), well tolerated | Catheter ablation | I | B | 55,85–87 |
| Flecainide, propafenone | IIa | C | 64,86,88–99 | |
| Sotalol, amiodarone, beta blockers | IIa | C | 100–104 | |
| Verapamil, diltiazem, digoxin | III | C | 105 | |
| WPW syndrome (with AF and rapid-conduction or poorly tolerated AVRT) | Catheter ablation | I | B | 55,57,85,106–111 |
| AVRT, poorly tolerated (no pre-excitation) | Catheter ablation | I | B | 55,57,85,106–111 |
| Flecainide, propafenone | IIa | C | 64,86,88–99 | |
| Sotalol, amiodarone | IIa | C | 100–104 | |
| Beta blockers | IIb | C | 105 | |
| Verapamil, diltiazem, digoxin | III | C | 105 | |
| Single or infrequent AVRT episode(s) (no pre-excitation) | None | I | C | |
| Vagal maneuvers | I | B | ||
| Pill-in-the-pocket— verapamil, diltiazem, beta blockers | I | B | 54,112 | |
| Catheter ablation | IIa | B | 55,57,85,106–111 | |
| Sotalol, amiodarone | IIb | B | 100–104 | |
| Flecainide, propafenone | IIb | C | 64,86,88–99,105 | |
| Digoxin | III | C | ||
| Pre-excitation, asymptomatic | None | I | C | |
| Catheter ablation | IIa | B | 55,57,85,106–111 |
The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily reflect a preferred sequence of administration. Please refer to text for details. For pertinent drug dosing information please refer to the ACC/AHA/ESC Guidelines on the Management of Patients With Atrial Fibrillation.
AF indicates atrial fibrillation; AVRT, atrioventricular reciprocating tachycardia; WPW, Wolff-Parkinson-White.