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Atrial Fibrillation and Wolff-Parkinson-White Syndrome (WPW)

By

L. Brent Mitchell

, MD, Libin Cardiovascular Institute of Alberta, University of Calgary

Last full review/revision Jan 2021
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Topic Resources

In Wolff-Parkinson-White syndrome, antegrade conduction occurs over an accessory pathway. If atrial fibrillation, develops this is a medical emergency as very rapid ventricular rates can develop.

Atrial fibrillation in Wolff-Parkinson-White syndrome

Ventricular response is very fast (RR intervals minimum of 160 msec). Shortly thereafter, ventricular fibrillation develops (lead II continuous rhythm strip at bottom).

Atrial fibrillation in Wolff-Parkinson-White syndrome

Treatment of Atrial Fibrillation and WPW Syndrome

  • Direct-current cardioversion

The treatment of choice for Wolff-Parkinson-White syndrome is direct-current cardioversion Direct-Current (DC) Cardioversion-Defibrillation The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic... read more . The usual rate-slowing drugs used in atrial fibrillation are not effective, and digoxin and the nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) are contraindicated because they may increase the ventricular rate and cause ventricular fibrillation. If cardioversion is impossible, drugs that prolong the refractory period of the accessory connection should be used. IV procainamide or amiodarone is preferred, but any class Ia, class Ic, or class III antiarrhythmic drug Drugs for Arrhythmias The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic... read more can be used.

Pearls & Pitfalls

  • Do not give digoxin or nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) to patients with atrial fibrillation and Wolff-Parkinson-White syndrome because these drugs may trigger ventricular fibrillation.

Drugs Mentioned In This Article

Drug Name Select Trade
LANOXIN
CALAN
CARDIZEM, CARTIA XT
No US brand name
NEXTERONE
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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