AF with WPW

Stable
1. Procainamide (Class Ia): drug of choice for AAVRT and preexcited AF (AF with WPW)

• 100mg/dose x 5minutes (not to exceed 50mg/min), repeat every 5 minutes PRN max of 1g, or
• 15-18mg/kg (1g in normal sized adult) over 25-30 minutes
• endpoint:
  1. arrythmia controlled
  2. QRS widens 50% of original width
  3. hypotension
  4. 17mg/kg achieved
• Maintenance: 1-4mg/minute infusion (reduced by 1/3 in patients with moderate renal or cardiac impairment and by 2/3 for severe)
  

2. Flecainide (Class Ic)

• 1.5mg/kg IV x 15 minutes, wait for 5 minutes, if not converted:
• 1.5mg/kg x 60 minutes

3. Propafenone (Class Ic)
4. Class III: Ibutelide, Dofetilide
5. Amiodarone Class III:
- ?not given in acute setting
- given in chronic/reverted rhythms, but also undesirable due to its side effects (include pulmonary and hepatic toxicity)

* Procainamide blocks AVN and bypass tract simultaneously
* Amiodarone blocks AVN split second before blocking bypass tract

AV nodal Blockers are contraindicated
No Adenosine, Beta blockers, CCB, Digoxin

Source: UpToDate