Recommendations for Long-Term Therapy of Accessory Pathway-Mediated Arrhythmias

ArrhythmiaRecommendationClassificationLevel of EvidenceReferences
WPW syndrome (pre-excitation and symptomatic arrhythmias), well toleratedCatheter ablationIB55,85–87
Flecainide, propafenoneIIaC64,86,88–99
Sotalol, amiodarone, beta blockersIIaC100–104
Verapamil, diltiazem, digoxinIIIC105
WPW syndrome (with AF and rapid-conduction or poorly tolerated AVRT)Catheter ablationIB55,57,85,106–111
AVRT, poorly tolerated (no pre-excitation)Catheter ablationIB55,57,85,106–111
Flecainide, propafenoneIIaC64,86,88–99
Sotalol, amiodaroneIIaC100–104
Beta blockersIIbC105
Verapamil, diltiazem, digoxinIIIC105
Single or infrequent AVRT episode(s) (no pre-excitation)NoneIC
Vagal maneuversIB
Pill-in-the-pocket— verapamil, diltiazem, beta blockersIB54,112
Catheter ablationIIaB55,57,85,106–111
Sotalol, amiodaroneIIbB100–104
Flecainide, propafenoneIIbC64,86,88–99,105
Pre-excitation, asymptomaticNoneIC
Catheter ablationIIaB55,57,85,106–111

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.