A-fib with WPW

  1. Have you ever noticed the (ACLS 2005 guidelines) drug recommendation for A-fib with WPW is Amiodarone, yet many articles out there shows that amiodarone kills these subset of patients. Amio is pretty much your class I through IV type of drug (potpourri of drugs) which has an av nodal blocker-type in it also. But they still recommend this drug as first class, which in reality it should be procainamide or DC cardioversion. Just a thought
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    About Christy1019

    Joined: Mar '08; Posts: 892; Likes: 1,851


  3. by   LoveANurse09
    Interesting, we dont do Amio here for those types.
  4. by   Christy1019
    If you don't mind me asking, where are you from, and what do you use at your facility?
  5. by   opensesame
    I've never heard amiodarone kills people with WPW. Can you post some articles that you have read?

    From what I know about WPW, it isn't a subset of atrial fibrillation as you posted. WPW is a re-entry tachycardia more similar to SVT.

    As you know, ACLS guidelines are for emergencies. I could definitely see treating unstable WPW with amiodarone if urgent treatment was needed. Cardioversion could also be a good option if patient was very unstable. Just because a treatment is in the ACLS guidelines doesn't mean that it is what is recommended for the patient long-term.

    I was always taught that the definitive treatment of WPW was an ablation to interrupt the pathway and that drug treatments were less desirable for recurrent, symptomatic WPW. A girlfriend of mine has this (she wore a holter for a week, and she was having 5-10 minutes episodes of HR's in the 180-200 range) and they put her on a beta-blocker which has reduced her episodes significantly. She is only 30 and didn't want an ablation due to the potential risk of needing a pacemaker afterward. I actually hadn't heard of procainamide as a drug of choice for WPW.