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Pre-excited tachyarrhythmia in Wolff-Parkinson-White syndrome — SCE Acute Medicine MCQ

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ModerateCardiovascular medicinePre-excited tachyarrhythmia in Wolff-Parkinson-White syndromeSCE Acute Medicine

A 29-year-old man presents with sudden palpitations. ECG shows a regular broad-complex tachycardia at 210/min; blood pressure is 118/70 mmHg and he is alert. A previous ECG in his phone shows a short PR interval and delta waves. Vagal manoeuvres have failed. What 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: B — Seek expert help and use procainamide or electrical cardioversion rather than AV nodal blockade

Pre-excited tachyarrhythmia should not be treated with AV nodal blockers because they may promote conduction down the accessory pathway and precipitate ventricular fibrillation. In stable pre-excited arrhythmia, specialist-supported procainamide or synchronised cardioversion is appropriate depending on local protocols and rhythm certainty. The broad complex and history of delta waves make simple SVT treatment unsafe.

Reference: Resuscitation Council UK ALS tachycardia algorithm; ESC SVT guidance