شاب عمره ٢٧ سنة معروف بمتلازمة WPW، جاء بخفقان شديد. الشاشة تظهر رجفاناً أذينياً سريعاً جداً وغير منتظم بسرعة ٢٢٠ بمركبات QRS عريضة متغيرة الشكل، وضغطه ١١٠/٧٠، وهو واعٍ. أي دواء يجب تجنبه؟

A 27-year-old with known WPW syndrome presents with severe palpitations. The monitor shows very fast irregular atrial fibrillation at 220 with broad, varying QRS complexes; BP 110/70 and he is alert. Which drugs must be avoided?

1. Synchronised cardioversion if he deteriorates
2. Adenosine or diltiazem
3. Continuous monitoring with the defibrillator ready
4. Procainamide under medical direction

Answer: B) Adenosine or diltiazem. In pre-excited AF (WPW), AV-nodal blockers such as adenosine, calcium channel blockers, beta-blockers and digoxin can push conduction down the accessory pathway and cause VF.