[轉貼] WPW with AF and RVR的急診治療

根據最新2015 AHA/ACC/HRS Guidelines for SVT,

急性發作的WPW with AF and RVR,使用靜脈注射的
Digoxin, Amiodarone, beta-blocker, Diltiazem, 及Verapamil 是有害的（class III)。

因為會增強 accessory pathway 的傳導，使心室率變得更快，引發心室的心率不整。

治療藥物是Procainamide,如果無法改善頻脈，就改用去顫電擊。

參考資料：
Guidelines for SVT Management. JACC April 5, 2016: e27-115
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

急救過程中，心跳過速的心律不整(Tachyarrhythmia)是較複雜的狀況。尤其以寬波QRS的心跳過速，VT經常會與因為accessary pathway而造成的寬波QRS的心跳過速難以辨認。

以AF with WPW and RVR的情況而言，根據2015 AHA/ACC/HRS的治療指引，是以藥物Procainamide 20 mg/min靜脈滴注，直到以下其中一種情形出現為止：
心律不整消失。低血壓。QRS寬度增加50%以上。已達最大劑量17mg/kg。

QT prolong或CHF勿用Procainamide。

如果Procainamide無法改善AF with WPW and RVR，就改以電擊。

以上資料轉自 https://www.facebook.com/groups/criticalcare119/permalink/10154282646840865/

[網友回覆] Actually. Without the resting EKG , the typical deta wave is seen . We cant dd it when the tectcardia with .narrow qrs except the wide qrs ., so after try the aminodarone . If it does not make. We can shift to proca namide , if bp stable. 

If bp unstable . The only choice is cardioversion . Do you agree ? 

Without the baseline eck or wide qrs. We can use aminodarone. Still withe EKG & bp monitor . Do you agree ??

[網友回覆] the procainamide is drugs of choice for WPW & VT , 

but the af with RVR * is common in CHF ,
in another way , the pre-excitation of wpw in CHF is also common, 0.1% ,
but procanimide is contraindicattion, in CHF,
-- the primitive conclusion AF rvr with wide qrs is cardioversion . 

the ratio of af c RVR due to WPW is relative low , the trial treatment is widely used in cardioleogy department , right ??

[網友回覆] The underlying subject is "stable tachycardia", hence procainamide is reasonable to use. If RVR in CHF, cardioversion is the priority choice. Right?