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Atrial fibrillation with Wolff-Parkinson-White syndrome — RCPSC EM MCQ

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HardCardiovascular emergenciesAtrial fibrillation with Wolff-Parkinson-White syndromeRCPSC EM

A 28-year-old man presents with palpitations and light-headedness. ECG shows an irregular wide-complex tachycardia at 210/min with beat-to-beat QRS variation; a prior ECG showed delta waves and a short PR interval. Blood pressure is 108/66 mmHg and he is mentating normally. What is the most likely diagnosis?

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

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Correct answer: B — Atrial fibrillation with Wolff-Parkinson-White syndrome

Irregular wide-complex tachycardia in a patient with prior delta waves is atrial fibrillation with pre-excitation. AV nodal blockers should be avoided.

Reference: CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist