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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 review/revision Jan 2023
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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 with atrial fibrillation 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 medications used in atrial fibrillation are not effective, and digoxin, adenosine, and the nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) that may be used in many other forms of supraventricular tachycardia are contraindicated because they may increase the ventricular rate and cause ventricular fibrillation. If cardioversion is impossible, medications 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 Medications 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, adenosine, or nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) to patients with atrial fibrillation and Wolff-Parkinson-White syndrome because these medications may trigger ventricular fibrillation.

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