In Wolff-Parkinson-White syndrome, what is the preferred curative treatment for tachyarrhythmias?

• A. Catheter ablation of the accessory pathway.
• B. Long-term antiarrhythmic drug therapy.
• C. Permanent pacing.
• D. Electrical cardioversion only.

Answer: (A)

In WPW, tachyarrhythmias arise because an accessory pathway creates a shortcut for electrical conduction, allowing reentrant circuits between the atria and ventricles. The most effective way to cure the problem long-term is to destroy that pathway with catheter ablation, usually using radiofrequency energy. By removing the substrate that supports reentry, episodes of tachycardia stop and the chance of recurrence is greatly reduced, with high success rates reported in experienced centers and the benefit of avoiding lifelong antiarrhythmic medication and its potential side effects. Other approaches—like antiarrhythmic drugs—can reduce symptoms but don’t eliminate the abnormal conduction pathway; electrical cardioversion is only an acute rhythm reset and does not prevent future episodes; pacing or long-term device therapies don’t address the underlying pathway. Hence, catheter ablation of the accessory pathway is the preferred curative treatment.