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Procainamide
61%
51/83
Adenosine
13%
11/83
Atenolol
Diltiazem
10%
8/83
Digoxin
1%
1/83
Select Answer to see Preferred Response
The correct answer is 1, procainamide, since patients with atrial fibrillation secondary to WPW should not be treated with atrioventricular (AV) nodal blockers. In the hearts of patients with WPW, there is an accessory pathway (known as the Bundle of Kent) that conducts depolarization directly from the atria to the ventricles, bypassing the AV node (Illustration A). This pathophysiology explains why AV nodal blockers should be avoided in WPW patients. AV nodal blockers (e.g. beta blockers, calcium channel blockers) only increase conduction across the accessory pathway, which can degenerate into lethal rhythms (e.g. ventricular fibrillation). Incorrect Answers: Answers 2-5: These drugs all block the AV node in some capacity and, therefore, are contraindicated in WPW.
5.0
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