The drug of choice in patients with Wolff-Parkinson- White syndrome with atrial fibrillation is -
The treatment of choice is Direct current cardioversion The usual rate-slowing drugs used in AF are not effective, and digoxin and the nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) are contraindicated because they may increase the ventricular rate and cause ventricular fibrillation. If cardioversion is impossible, drugs that prolong the refractory period of the accessory connection should be used. IV procainamide or amiodarone is preferred, but any class Ia, class Ic, or class III antiarrhythmic can be used. People with atrial fibrillation and rapid ventricular response are often treated with amiodaroneor procainamideto stabilize their hea rate. Procainamide and cardioversion are now accepted treatments for conversion of tachycardia found with WPW.Amiodarone was previously thought to be safe in atrial fibrillation with WPW, but after several cases of ventricular fibrillation, it is no longer recommended in this clinical scenario. AV node blockers should be avoided in atrial fibrillation and atrial flutter with WPW or history of it; this includes adenosine, diltiazem, verapamil, other calcium channel blockers, and beta blockers. They can exacerbate the syndrome by blocking the hea's normal electrical pathway (therefore oring 1:1 atrial to ventricle conduction through the pre-excitation pathway, potentially leading to unstable ventricular arrhythmias). Ref 20 edition pg 1434
Digitalis
Procainamide
Verapamil
Adenosine
C.V.S