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WPW Syndrome — RACP Adult Medicine MCQ

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ModerateCardiologyWPW SyndromeRACP Adult Medicine

A 35-year-old man presents with palpitations and presyncope. His ECG shows a short PR interval (<120 ms), delta waves, and a wide QRS complex. What is the most dangerous arrhythmia this patient is at risk of?

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Correct answer: B — Atrial fibrillation with rapid pre-excited ventricular response

Wolff-Parkinson-White (WPW) syndrome with a delta wave indicates an accessory pathway (bundle of Kent). The most dangerous arrhythmia is pre-excited AF, where rapid conduction down the accessory pathway can result in ventricular fibrillation and sudden death. AV nodal blocking agents (verapamil, digoxin, adenosine) are CONTRAINDICATED in pre-excited AF as they preferentially direct conduction down the accessory pathway. Procainamide or DC cardioversion is appropriate.

Reference: eTG – 2025 – Cardiovascular; ESC – 2019 – SVT Guidelines