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Pre-excited Atrial Fibrillation (WPW) — EECC MCQ

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HardArrhythmia & ElectrophysiologyPre-excited Atrial Fibrillation (WPW)EECC

A 35-year-old woman with Wolff-Parkinson-White syndrome and pre-excited atrial fibrillation (irregularly irregular broad-complex tachycardia with varying QRS morphology, shortest pre-excited RR interval 220 ms) presents to the emergency department. Heart rate is 200 bpm, blood pressure 100/70 mmHg. She is conscious. Which treatment is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Synchronised DC cardioversion

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · E = shown as D · C = shown as E

Pre-excited AF in WPW is potentially life-threatening. DC cardioversion is recommended for haemodynamically compromised pre-excited AF. Adenosine (A), verapamil (B), and digoxin (D) are all contraindicated as they block the AV node, potentially enhancing conduction down the accessory pathway and precipitating VF. Amiodarone (E) may paradoxically increase ventricular rate in pre-excited AF; electrical cardioversion is safer.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation