Every paramedic needs to put on their radar the unfortunate combination of Atrial Fibrillation (or flutter) and WPW. These patients can form a reentry circuit in either direction - they can have either ANTIdromic or ORTHOdromic AVRT. However, they have a dangerous underline A-fib that is waiting to turn that reentry rhythm into V-fib. How?
If a patient has A-fib, their atrium is dealing with over 500 impulses per minute. The ventricles are usually kept safe because the AV node acts as a gatekeeper, only letting a small amount of those impulses through. However, the Bundle of Kent is no gatekeeper - it's an unregulated gap in the fence. If we were to give an agent that blocks the AV node, there is a strong possibility that the A-fib will transfer its impulse rate to the ventricles, and then we would be dealing with V-fib. Anytime you see an irregular tachycardia, regardless of whether it's wide or narrow, think A-fib, and possibly WPW with A-fib.
Check out the full episode in the link below.
[ Ссылка ]
