A patient with WPW syndrome and atrial fibrillation is brought to the ED with rapid ventricular rate via the accessory pathway. Which drug is CONTRAINDICATED in this situation?
- A Procainamide
- B Verapamil ✓
- C Flecainide
- D Amiodarone
Correct answer: B. Verapamil
Explanation
In WPW with AF, verapamil (and digoxin) are contraindicated because they slow AV nodal conduction while leaving or even facilitating conduction through the accessory pathway, increasing ventricular rate to dangerous levels (potentially causing ventricular fibrillation). Procainamide, flecainide, and amiodarone can block both the AV node and accessory pathway conduction, making them acceptable options for acute management.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.