A 40-year-old man with structurally normal heart has recurrent narrow-complex regular tachycardia (SVT) with heart rate 190/min. ECG during sinus rhythm shows a delta wave and short PR interval. He had 3 episodes requiring adenosine termination in the past year. What is the most appropriate management?
- A Lifelong beta-blocker therapy
- B Radiofrequency catheter ablation of the accessory pathway ✓
- C Amiodarone
- D Digoxin
Correct answer: B. Radiofrequency catheter ablation of the accessory pathway
Explanation
Wolff-Parkinson-White (WPW) syndrome with symptomatic recurrent SVT is a class I indication for electrophysiology study and radiofrequency catheter ablation of the accessory pathway. Ablation achieves cure in >95% of cases with low complication rates and is preferred over lifelong antiarrhythmic therapy in symptomatic young patients. Digoxin and verapamil are contraindicated in WPW as they can enhance conduction over the accessory pathway, potentially precipitating VF during AF. Amiodarone is reserved for complex cases.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.