In a patient with Wolff-Parkinson-White pattern, what is the next step in management?

• A. Immediate electrical cardioversion
• B. Cardiac electrophysiology study
• C. Start amiodarone therapy
• D. Observation

Answer: (B)

In WPW patterns, the priority is to assess the risk of dangerous tachyarrhythmias and plan definitive therapy. An invasive electrophysiology study allows precise evaluation of whether the accessory pathway conducts conduction antegradely and whether AV reentrant tachycardias can be induced. It also maps the pathway to guide catheter ablation, which can be curative by removing the substrate for reentry. If the study shows a high‑risk pathway or inducible tachyarrhythmias, ablation is pursued.

Immediate electrical cardioversion is reserved for patients who are unstable or actively deteriorating from a tachyarrhythmia, not as a routine next step for a WPW pattern. Starting amiodarone isn’t the standard initial step for risk stratification in WPW, and observation alone may be appropriate only in truly asymptomatic cases without concerning risk features. The key approach is risk stratification with an electrophysiology study to determine the need and approach for ablation.