When is surgery required for pre-excitation syndrome?

  Class I: a. Patients with symptomatic persistent atrioventricular fold tachycardia who have failed pharmacological therapy or who are intolerant or unwilling to take antiarrhythmic drugs for a long time to control the above arrhythmia. b. Patients with atrial fibrillation or other rapid atrial arrhythmias with bypass antegrade transmission due to rapid ventricular rate who have failed pharmacological therapy or who are intolerant or unwilling to take antiarrhythmic drugs for a long time. c. Patients with atrial fibrillation or other rapid atrial arrhythmias with bypass antegrade transmission due to rapid ventricular rate.  Class II: a. Patients with atrial fibrillation tachycardia confirmed during electrophysiological examination or ablation for other arrhythmias, or patients with rapid ventricular rate due to atrial fibrillation with bypass antegrade transmission. b. Patients with asymptomatic pre-excitation syndrome due to spontaneous tachyarrhythmias and abnormal electrocardiograms that may affect the patient’s life, employment, important activities and mental status, and public safety. c. Patients with atrial fibrillation with bypass antegrade transmission, but not rapid ventricular rate. but not a rapid ventricular rate. d. The patient has a family history of sudden cardiac death.  Class III: Patients with atrial fibrillation tachycardia who are effectively treated with medications and can tolerate their therapy and prefer long-term medication over ablation for arrhythmia control.