A 28-year-old woman presents with recurrent episodes of palpitations with sudden onset and offset, heart rate 180 bpm, regular narrow complex tachycardia, and a short PR interval with delta waves on sinus rhythm ECG. Electrophysiology study confirms a left lateral accessory pathway. What is the definitive treatment?

• A Long-term flecainide therapy
• B Digoxin for rate control
• C Amiodarone as first-line therapy
• D Radiofrequency catheter ablation of the accessory pathway ✓

Explanation

Wolff-Parkinson-White syndrome with symptomatic SVT due to an accessory pathway is best treated with radiofrequency catheter ablation, which achieves cure rates >95% with low complication rates. Ablation eliminates the pathway and prevents recurrence of both orthodromic AVRT and potentially life-threatening pre-excited AF. Flecainide and other antiarrhythmics suppress but do not cure. Digoxin is contraindicated in WPW as it shortens the refractory period of the accessory pathway, potentially accelerating pre-excited AF. Amiodarone may be used acutely but ablation is preferred.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.