Pre-excited AF in WPW — RACP Adult Medicine MCQ

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HardCardiologyPre-excited AF in WPWRACP Adult Medicine

A 32-year-old woman with known Wolff-Parkinson-White syndrome presents to ED with a broad-complex irregular tachycardia at 210 bpm. BP is 85/50 mmHg. Which is the most appropriate immediate management?

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Correct answer: E — Synchronised DC cardioversion

This presentation is consistent with pre-excited AF (AF conducting via the accessory pathway) in WPW syndrome. The patient is haemodynamically unstable. Synchronised DC cardioversion is the first-line treatment for any unstable tachyarrhythmia. AV nodal blocking agents (adenosine, verapamil, digoxin, beta-blockers) are contraindicated as they may promote exclusive conduction via the accessory pathway, causing VF.

Reference: CSANZ – 2016 – Arrhythmia Guidelines; eTG Cardiovascular 2024