A 22-year old had a pre-sports screening exam during which the following ECG was obtained (NB insert). He has no symptoms and denies use of any medications. He underwent a controlled exercise test and only developed intermittent pre-excitation without symptoms. What is the next step in his management?
- a. Echocardiogram
- b. Electrophysiologic study
- c. Observation
- d. Start on amiodarone
- e. Insert an ICD
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WPW syndrome occurs when there is an antegradely conducting accessory pathway (AP), as well as one or more types of supraventricular arrhythmias.
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The term accessory pathway refers to the presence of an anomalous pathway that connects the atria and ventricles, thereby short-circuiting the normal AV node and His-Purkinje system.
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A pattern of pre-excitation on a 12-lead ECG reflects the presence of an antegradely conducting accessory pathway and consists of the constellation of a short PR interval, a widened QRS complex, and a delta wave – which is a slow upstroke of the QRS complex.
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Most electrophysiologists will discuss the option of performing an EPS as a risk stratification tool to all asymptomatic patients with a pattern of pre-excitation on an ECG. If high-risk features are found, catheter ablation can be performed in the same setting.