What drugs are contraindicated in WPW?

What drugs are contraindicated in WPW?

Safe practice in SVT with WPW

What is the drug of choice for WPW?

The drug of choice for the treatment of regular supraventricular (reciprocating) tachycardia with narrow QRS complexes, which is the most common arrhythmia in the WPW syndrome, is propranolol. Digitalis is almost equally effective in this case.

Why dont you give adenosine to WPW?

The concern with using adenosine in patients with WPW is that if the AV node is blocked than impulses from the atria will be able to reach the ventricles at a very rapid rate, since they are not slowed down through the accessory pathway as they are at the AV node.

Can adenosine be used in WPW?

Adenosine (Adenocard, Adenoscan) It can interrupt atrioventricular reentrant tachycardia (AVRT) by blocking conduction in the AV node to restore normal sinus rhythm in paroxysmal supraventricular tachycardia (PSVT), including PSVT associated with WPW syndrome.

Is beta blocker contraindicated in WPW?

In addition to amiodarone, AV nodal blocking agents such as IV beta blockers, calcium-channel blockers, digoxin, and adenosine are also contraindicated in patients with PES and atrial fibrillation. Any of these medications may accelerate the ventricular rate and cause ventricular fibrillation.

Why is flecainide used in WPW?

Administered during preexcited atrial fibrillation, flecainide consistently slows the ventricular response and converts the majority of cases to sinus rhythm. Serious ventricular proarrhythmia is seen almost exclusively in patients with structural cardiac disease.

What happens if adenosine doesnt work?

If adenosine does not work, atrioventricular (AV) nodal blocking agents like calcium channel blockers or beta-blockers should be used, as most patients who present with PSVT have AV nodal reentrant tachycardia (AVNRT) or AV reentrant tachycardia (AVRT).

What is a AVRT?

AV reentrant (or reciprocating) tachycardia (AVRT) is a reentrant tachycardia with an anatomically defined circuit that consists of two distinct pathways, the normal AV conduction system and an AV accessory pathway, linked by common proximal (the atria) and distal (the ventricles) tissues.

Is WPW Antidromic or Orthodromic?

Only about 5% of the tachycardias in patients who have WPW syndrome are antidromic tachycardias; the remaining 95% are orthodromic.

Is WPW AVRT or avnrt?

The most common type of tachycardia in individuals with WPW syndrome is orthodromic AVRT where the normal conduction system constitutes the anterograde pathway and the accessory pathway constitutes the retrograde one.

Where does the reentry impulse travel in orthodromic AVRT?

In orthodromic AVRT the re-entry impulse circulates in antegrade direction through the atrioventricular node. In antidromic AVRT the impulse travels in retrograde direction through the atrioventricular node.

When to use antidromic AVRT in WPW syndrome?

Antidromic AVRT is a very rare finding in WPW syndrome during an EP study. Catheter ablation is the treatment of choice for patients who have symptomatic WPW syndrome. Catheter ablation can be especially challenging when the accessory pathway is in close proximity to the normal conduction pathways.

Why is AVRT a specific reentrant of tachycardia?

While other arrhythmias can utilize the accessory pathway for conduction from the anatomic site of tachycardia origin to other regions of the heart (eg, atrial fibrillation and atrial flutter) ( figure 2 ), AVRT is a specific reentrant tachycardia in which the accessory pathway is necessary for initiation and maintenance of the tachycardia [ 2 ].

How does an antidromic AVRT occur in the sinus?

In this situation, an antidromic AVRT can occur with electrical conduction of the sinus impulse via the preexcited accessory pathway (antegrade fashion), and then retrograde via the normal AV node to create a circuit reentry rhythm.