Eart rate are considered at lower risk of scd. This is because the loss of the delta wave shows that the accessory pathway cannot conduct electrical impulses at a high rate (in the anterograde direction). These individuals will typically not have fast conduction down the accessory pathway during episodes of atrial fibrillation. viagra no prescription Risk stratification is best performed via programmed electrical stimulation (pes) in the cardiac electrophysiology lab. This is an invasive procedure, in which the rate of impulse propagation via the accessory pathway is determined by stimulating the atria and by inducing transient atrial fibrillation. viagra canada High risk features that may be present during pes include an effective refractory period of the accessory pathway less than 270 ms, multiple pathways, septal location of pathway, and inducibility of supraventricular tachycardia. female viagra ebay Individuals with any of these high risk features are generally considered at increased risk for scd and should be treated accordingly. what is up with the bathtubs in the viagra commercials [6] it is unclear whether invasive risk stratification (with programmed electrical stimulation) is necessary in the asymptomatic individual. [7] while some groups advocate pes for risk stratification in all individuals under 35 years old, others only offer it to individuals who have history suggestive of a tachyarrhythmia, since the incidence of sudden death is so low. cheap viagra [3] [4] treatment edit acutely, people with wpw who are experiencing a tachydysrhythmia may require electrical cardioversion if their condition is critical, or, if more stable, medical treatment may be used. discount pharmacy viagra Patients with atrial fibrillation and rapid ventricular response are often treated with amiodarone or procainamide to stabilize their heart rate. viagra online Adenosine and other av node blockers should be avoided in atrial fibrillation and atrial flutter with wpw or history of it; this includes adenosine, diltiazem, verapamil, other calcium channel blockers and beta-blockers. viagra super active reviews Patients with a rapid heart beat with narrow qrs complexes (circus movement tachycardias) may also be cardioverted, alternatively, adenosine may be administered if equipment for cardioversion is immediately available as a backup. viagra canada online The definitive treatment of wpw syndrome is a destruction of the abnormal electrical pathway by radiofrequency catheter ablation. This procedure is performed almost exclusively by cardiac electrophysiologists. generic viagra Radiofrequency catheter ablation is not performed in all individuals with.