Written on behalf of the Sanger Heart and Vascular Education Group
A 37-year-old man is brought to the emergency department with episodes of palpitations. There he has intermittent episodes of wide complex tachycardia. He is hemodynamically stable. The following electrocardiogram (ECG) is obtained:
Figure 1
Which of the following is the best course of action?
Show Answer
The correct answer is: E. For immediate treatment, IV procainamide should be given.
This is a classic Wolff-Parkinson-White syndrome ECG. The treatment of choice is IV procainamide, probably the only time you'll reach for this agent. Amiodarone would not be the agent to use long term given its side effects. Immediate cardioversion would not be the best choice because the patient is having this rhythm intermittently and is hemodynamically stable. IV esmolol or digoxin could potentially worsen the patient's condition.
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