CHEST SEEK® Author Commentary (7 New Flashcards! June 2026)-Preexcited Atrial Fibrillation - Commentary From Steven M. Hollenberg, MD, FCCP

Preexcited Atrial Fibrillation - Commentary From Steven M. Hollenberg, MD, FCCP

Video Transcription

Video Summary

The EKG shows atrial fibrillation with Wolff-Parkinson-White syndrome: an irregular rhythm with variable QRS widths and very rapid ventricular conduction through an accessory pathway. This is dangerous because AV nodal blockers can worsen conduction through the bypass tract. Do not give adenosine, esmolol, or lidocaine. The best treatment from the options is procainamide, which slows conduction in the accessory pathway. This rhythm is a classic high-yield exam topic and should be recognized quickly, especially when an irregular tachycardia appears unusually fast and wide with beat-to-beat variation.

Asset Caption

This question is found in the Cardiovascular Disorders module in the Critical Care Medicine Collection.

Keywords

atrial fibrillation

Wolff-Parkinson-White syndrome

accessory pathway

procainamide

irregular wide-complex tachycardia