The Role of Oral Amiodarone in Treating Pre-Excited Atrial Fibrillation in Low-Resource Rural Areas: A Case Report

Abstract

Background: Wolff-Parkinson-White (WPW) syndrome is a pre-excitation syndrome defined by the presence of an accessory pathway responsible for ventricular pre-excitation that can lead to severe arrhythmias. Coexistence with Atrial Fibrillation (AF) exposes potential degenerescence into ventricular arrhythmias when atrial impulses are transmitted along the accessory pathway. The choice of drug in this special presentation must be noteworthy to avoid potentially dangerous treatments, such as digoxin. In rural areas, where treatment options may be limited, oral amiodarone offers a viable alternative for rate control due to its availability.

Case Illustration: We report a case of a 54-year-old female with newly diagnosed pre-excited AF who routinely consumed digoxin and presented with palpitations, general weakness, and near syncope. The symptoms worsened from three years ago when the patient was initially diagnosed solely with AF and began her medication regimen at a different hospital as part of her routine care. After switching therapy by using oral amiodarone based on the clinical, electrocardiography, and echocardiography findings, better symptoms and clinical outcomes were observed.

Conclusion: This case highlights the potential role of oral amiodarone as an alternative treatment for pre-excited AF in rural areas. Underdiagnosed pre-excited AF can lead to sudden cardiac death, especially when treatment errors occur. A comprehensive diagnosis and appropriate therapy are crucial for improving clinical outcomes for patients in such settings.