A 55-year-old woman with Wolff-Parkinson-White syndrome complicated by atrial fibrillation presents to the emergency department in rapid AF. Which drug is CONTRAINDICATED in this setting?

• A Procainamide
• B Flecainide
• C Amiodarone
• D Digoxin ✓

Explanation

In WPW with AF, the accessory pathway (Bundle of Kent) can conduct impulses rapidly to the ventricle. Digoxin and verapamil are contraindicated because they selectively block the AV node, unmasking the accessory pathway to conduct AF impulses at very high ventricular rates, potentially precipitating ventricular fibrillation. Procainamide slows conduction in both the AV node and the accessory pathway and is the preferred drug. Amiodarone and flecainide are also acceptable in this setting.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.