Which drugs act on the atrioventricular (AV) node in the treatment of Wolff-Parkinson-White (WPW) syndrome?

Updated: Jan 08, 2017
  • Author: Christopher R Ellis, MD, FACC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Answer

Verapamil and diltiazem (calcium channel blockers), metoprolol and atenolol (beta-blockers), and digitalis all prolong conduction time and refractoriness in the AV node.

Verapamil and metoprolol do not affect conduction in the AV bypass tract (may slow Mahaim fibers or atriofascicular pathway conduction). IV verapamil can speed up the ventricular response in patients with WPW syndrome who have AF. Verapamil is not recommended as a sole agent in patients with WPW syndrome.

Digitalis shortens refractoriness in the myocardium and in the bypass tract. Thus, it may accelerate the ventricular response in the setting of AF in a patient with WPW syndrome. It should generally be avoided.

Adenosine causes profound changes in AV nodal conduction leading to transient AV block and typically does not affect the accessory pathway conduction. Adenosine should not be used in this setting and could induce VF.

Digoxin is contraindicated in patients with WPW syndrome, although it may play some role in children only. Some deaths from WPW syndrome have been associated with digoxin use.


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