Why is atrial fibrillation with Wolff-Parkinson-White pattern considered high risk for sudden death?

• A. Rapid conduction over accessory pathway during AF can cause extremely high ventricular rates and VF; ablation is preferred.
• B. AF with WPW pattern is never dangerous.
• C. Rate control alone prevents sudden death in WPW.
• D. Abstaining from procedures prevents sudden death.

Answer: (A)

When a person has Wolff-Parkinson-White pattern, there is an extra electrical pathway that can carry impulses from the atria to the ventricles bypassing the normal AV node gatekeeper. During atrial fibrillation, the atria beat very rapidly, and if the accessory pathway conducts quickly, the ventricles can be driven at extremely high rates. The AV node’s filtering no longer limits these impulses, so the heart can enter ventricular tachyarrhythmias or even ventricular fibrillation, which can cause sudden death. The definitive and safest approach is to remove the dangerous conduit by catheter ablation of the accessory pathway, eliminating the possibility of such rapid ventricular conduction. Rate-control strategies that rely on slowing conduction through the AV node do not address the underlying risk and can even be harmful in this context.