Perioperative Management of Patients With Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White (WPW) syndrome involves an accessory atrioventricular pathway predisposing patients to tachyarrhythmias, creating unique perioperative challenges during non-cardiac surgery. WPW syndrome affects 0.15–0.25% of the population and carries a 3–4% lifetime risk of sudden cardiac death. Patients with WPW syndrome face primary perioperative arrhythmias including atrioventricular reentrant tachycardia (AVRT) at 150–250 bpm and potentially fatal pre-excited atrial fibrillation exceeding 250 bpm. Radiofrequency catheter ablation achieves 94.1% acute success with 1% major complication rates. Even with a history of ablation, a 6% recurrence rate exists. Vigilance remains necessary regardless of prior procedures. Critical management strategies include avoiding AV nodal blockers during pre-excited atrial fibrillation, using Procainamide as first-line therapy for acute tachyarrhythmias, maintaining deep anesthesia with high opioid doses, ensuring immediate availability of emergency medications and defibrillation equipment, and implementing multi-lead ECG monitoring with arterial access. Safe surgical outcomes require thorough preoperative assessment, consideration of prophylactic ablation for high-risk patients, avoidance of arrhythmogenic triggers, vigilant intraoperative monitoring, and readiness for immediate cardioversion. Modified Advanced Cardiac Life Support protocols and multidisciplinary collaboration between anesthesiologists, cardiologists, and surgeons are essential for optimizing patient safety and outcomes in WPW syndrome management.