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Wolff-Parkinson-White with atrial fibrillation — ABEM Board MCQ

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HardCardiovascular emergenciesWolff-Parkinson-White with atrial fibrillationABEM Board

A 36-year-old man arrives with palpitations and mild dyspnea. Triage acuity is ESI 2; BP 118/70 mm Hg, HR 190/min, SpO2 98%. ECG shows irregular wide-complex tachycardia with varying QRS morphologies and delta waves on a prior ECG. He is awake and perfusing. Which of the following is the most appropriate next step in management?

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

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Correct answer: A — Give IV procainamide and prepare for cardioversion if unstable

Pre-excited atrial fibrillation requires an agent such as procainamide; AV nodal blockers can accelerate conduction through the accessory pathway.

Reference: AHA ACLS 2025 tachycardia guidance