title: Tachydysrhythmia treatment and adverse events in patients with wolff-Parkinson-white syndrome.
abstract: BACKGROUND
  Current guidelines recommend avoiding atrioventricular-nodal blocking agents (AVNB) when treating tachydysrhythmias in Wolff-Parkinson-White syndrome (WPW) patients.
  
  
  OBJECTIVE
  We investigated medications selected and resulting outcomes for patients with tachydysrhythmias and WPW.
  
  
  METHODS
  In this single-center retrospective cohort study, we searched a hospital-wide database for the following inclusion criteria: WPW, tachycardia, and intravenous antidysrhythmics. The composite outcome of adverse events was acceleration of tachycardia, new hypotension, new malignant dysrhythmia, and cardioversion. The difference in binomial proportions of patients meeting the composite outcome after AVNB or non-AVNB (NAVNB) treatment was calculated after dividing the groups by QRS duration. A random-effects mixed linear analysis was performed to analyze the vital sign response.
  
  
  RESULTS
  The initial database search yielded 1158 patient visits, with 60 meeting inclusion criteria. Patients' median age was 52.5 years; 53% were male, 43% presented in wide complex tachycardia (WCT), with 75% in atrial fibrillation (AF) or flutter. AVNBs were administered in 42 (70%) patient visits. For those patients with WCT in AF, the difference in proportions of patients meeting the composite outcome after AVNBs vs. NAVNBs treatment was an increase of 3% (95% confidence interval [CI] -39%-49%), and for those with narrow complex AF it was a decrease of 13% (95% CI -37%-81%). No instances of malignant dysrhythmia occurred. Mixed linear analysis showed no statistically significant effects on heart rate, though suggested a trend toward increasing heart rate after AVNB in wide complex AF.
  
  
  CONCLUSIONS
  In this sample of WPW-associated tachydysrhythmia patients, many were treated with AVNBs. The composite outcome was similarly met after use of either AVNB or NAVNB, and no malignant dysrhythmias were observed.
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, Georgia.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Siegelman
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Marill
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Adler
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D004554:Electric Countershock; D005260:Female; D019983:Guideline Adherence; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000503:physiopathology
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: AV-nodal blockade; WPW; Wolff-Parkinson-White syndrome; atrial fibrillation; cardiovascular emergencies; tachydysrhythmia