What is the treatment of choice for antidromic WPW?

In the context of treating antidromic Wolff-Parkinson-White (WPW) syndrome, the choice of Procainamide is well-supported due to its ability to effectively slow down conduction through accessory pathways. Antidromic WPW occurs when the electrical impulse flows from the ventricles back to the atria via the accessory pathway, which is the opposite of orthodromic conduction.

Procainamide, being a Class IA antiarrhythmic, is particularly effective in managing this condition. It works by prolonging the action potential and refractory period in cardiac tissue, which decreases the conduction velocity in the accessory pathway. This can help in converting the arrhythmia back to normal sinus rhythm or at the very least, in controlling the rapid heart rate caused by antidromic conduction.

Other options may not be appropriate for managing this specific type of arrhythmia. Beta-blockers can help in some supraventricular tachycardias but are generally avoided in WPW due to the risk of promoting rapid conduction through the accessory pathway. Adenosine is effective for terminating orthodromic WPW but is less effective in antidromic cases. Calcium channel blockers can also increase conduction through the accessory pathway in antidromic