A-fib with WPW

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    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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    Interesting, we dont do Amio here for those types.
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    If you don't mind me asking, where are you from, and what do you use at your facility?
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    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.

    http://www.americanheart.org/present...dentifier=4785


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