November 29, 2010

USMLE 2 Question 23

A patient has symptomatic WPW syndrome but is refusing surgery.

The medication of choice is:

a) Subclass IB drugs alone plus an AV nodal blocker
b) Subclass IV drugs plus an AV nodal blocker
c) subclass II drugs
d) an AV nodal blocker alone
e) a membrane-active antiarrhythmic drug (class IC or III) plus an AV nodal blocker

The correct answer is E

The 3 main treatment modalities for WPW syndrome are drug therapy, electrical (ie, RF) ablation, and surgical ablation.

Ablation is the first-line treatment for symptomatic WPW syndrome. It has replaced surgical treatment and most drug treatment. However, drug therapy can be useful in some instances, such as in patients who refuse ablation or in patients in whom ablation fails in one or two attempts.

For patients treated longitudinally with pharmacotherapy, consideration should be given to a membrane-active antiarrhythmic drug (class IC or III) with an AV nodal blocker, rather than just an AV nodal blocker, because of the potential for extremely rapid rates during preexcited atrial fibrillation or flutter.

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