What is the preferred antiarrhythmic treatment for stable Wolff-Parkinson-White syndrome?

In the management of stable Wolff-Parkinson-White (WPW) syndrome, the preferred antiarrhythmic treatment is procainamide. This choice is based on its ability to effectively interrupt reentrant circuits that can occur in WPW, particularly those involving atrioventricular reentrant tachycardia (AVRT). Procainamide works by blocking sodium channels, which can help to slow conduction through the accessory pathway and restore normal sinus rhythm.

Procainamide is especially advantageous in this scenario because it can help stabilize the patient by converting tachycardia to normal sinus rhythm without exacerbating the situation. Its intravenous administration allows for rapid onset of action in an emergency setting, making it a valuable tool for acute management.

While other agents such as amiodarone, flecainide, and ibutilide can also have antiarrhythmic effects, they are generally not preferred for WPW syndrome. Amiodarone has a broader spectrum of action and is often used in atrial fibrillation but can be less effective regarding the specific conduction characteristics of WPW. Flecainide is contraindicated in patients with underlying structural heart disease and can potentially worsen the situation in WPW due to its action on the accessory