What is the indication for catheter ablation in accessory pathway–mediated tachycardias (AVRT or WPW)?

• A. Recurrent or drug-refractory episodes or high-risk features; ablation is curative.
• B. Ablation is never indicated.
• C. Ablation is only for non-suspect patients.
• D. Ablation should be performed only after pharmacologic therapy fails.

Answer: (A)

The main point is that catheter ablation is considered when accessory-pathway–mediated tachycardias (AVRT or WPW) cause recurrent symptoms, are not controlled by medications, or there are high-risk features that raise the danger of serious events. Eliminating the accessory pathway with ablation is curative, stopping the reentrant circuit that drives the tachycardias.

Why this is the best fit: Ablation targets and destroys the pathway responsible for the abnormal conduction, so the recurrent episodes stop and the patient often remains symptom-free in the long term. This is particularly valuable for people who have frequent episodes, those who do not tolerate or respond to antiarrhythmic drugs, or those with high-risk features like pre-excited atrial fibrillation, where rapid conduction over the pathway can be dangerous. While drugs can help manage symptoms, they do not remove the substrate that enables the tachycardia; ablation offers a definitive cure.

In contrast, other options imply that ablation is rarely or never indicated, or that it must wait until pharmacologic therapy fails, or that it’s only for certain patients. In clinical practice, the decision weighs symptom burden, recurrence, and risk, and ablation is an appropriate and often preferred option when those factors are present.