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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com


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jueves, 3 de diciembre de 2015


EM Resident Magazine
EM Resident - By Sadowski A, Hausberger M and Barr - On 12, 02, 2105
"A healthy 28-year-old male with no past medical history presents to the emergency department with palpitations and dizziness. Vital signs are within normal limits except for a recorded heart rate of 220 bpm. An ECG is obtained:
Figure 1
Post-cardioversion ECG:
Figure 2
It is imperative to recognize AF with WPW, as incorrect treatment with AV nodal blocking agents can be fatal.Blocking the AV node in these patients will result in preferential use of the accessory pathway. Rates may exceed 300 or 400 bpm and are at extreme risk for degeneration into ventricular fibrillation (VF). Thus, an irregular wide complex tachycardia with rates approaching 300 bpm, bizarre and varying QRS morphologies, and a stable axis, must be treated as AF with WPW until proven otherwise. Procainamide (50-100 mg every 2 min to a max dose of 17 mg/kg) or ibutilide (0.01 mg/kg maximum 1 mg over 10 min) are the treatments of choice for chemical conversion.4 Amiodarone is controversial but has been known to cause decompensation into VF, due to its calcium-channel blocking and beta-blocking effects.5 Electrical cardioversion is the treatment of choice for unstable patients, however it is also an acceptable treatment for stable patients. Finally, it is recommended that cardiology be involved early to further guide your treatment decisions."