Afib with Pre-excitation

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    Afib with Pre-excitation

    A young patient comes into your RESUS area complaining of palpitations, and you get handed this EKG. What do you do?

    A fib with an accessory pathway can go so fast that it can be misdiagnosed as V tach/ SVT, however if misdiagnosed, the usual treatment could cause you to push the patient into v fib and even death!

    Can reach rates of 250-300 as opposed to our usual bread and butter a fib with RVR

    Avoid all AV nodal blockers if concerned that there may be an accessory pathway involved

    From LITFL

    Procainamide is your agent of choice

    A great review of the pre-excitation syndromes

    http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/

    EKG Guru Amal Mattu has a wonderful 20 min video on this topic that explains it really well

    http://ekgumem.tumblr.com/post/104045855859/17-yom-with-palpitations-what-drugs-are

     

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