Pathophysiological Interplay and Clinical Implications of Preexcited Atrial Fibrillation in Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac conduction disorder characterized by the presence of an accessory pathway (AP) that facilitates abnormal ventricular preexcitation, predisposing affected individuals to potentially life-threatening arrhythmias. Among these, preexcited atrial fibrillation (AF) represents a critical clinical entity due to its propensity for rapid ventricular conduction, which may degenerate into ventricular fibrillation (VF) and sudden cardiac death (SCD). This review examines the intricate electrophysiological mechanisms underlying the coexistence of WPW and preexcited AF, emphasizing the role of anomalous atrioventricular (AV) conduction in perpetuating reentrant circuits and facilitating irregular, high-rate ventricular responses. Furthermore, we explore contemporary risk stratification paradigms, diagnostic modalities including 12-lead electrocardiography (ECG) and invasive electrophysiological studies (EPS), and evidence-based therapeutic approaches ranging from pharmacologic management to catheter ablation. By synthesizing current literature, this article aims to elucidate the clinical challenges and prognostic implications of preexcited AF in WPW syndrome, advocating for a tailored, patient-centric approach to mitigate adverse outcomes.