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Abstract. Wolff-Parkinson-White (WPW) syndrome is one of the most common pre-excitation syndrome. Accessory pathway formed between the atria and ventricles become conduction path other than the atrioventricular node. The occurrence of atrial fibrillation (AF) in the WPW syndrome cases are quite rare, and seldom reported in the medical literature. WPW syndrome that have a tachyarrhythmia has a specific treatment and contraindications, thus giving preferred treatment should avoid the potential occurrence of ventricular fibrillation (VF). We describe adult male presenting with a very rapid, irregular wide QRS complex tachycardia, with hemodynamic instability. Successful cardioversion performed in the emergency room (ER). ECG results after cardioversion showed normal sinus rhythm with accompanying evidence of accessory pathway in accordance with WPW type A with the localization of the LV free wall. Medical personnel need special attention in emergency cases. AF with aberrant conduction and ventricular tachycardia are the very first thing to be considered in cases of wide QRS complex tachycardia. However, medical personnel need to consider that WPW syndrome accompanied with AF will give an increased heart rate (> 200 x / min), wide QRS complex and irregular rhythm, especially when choosing a pharmacological therapy. Several hypotheses which can cause AF in patients with WPW including spontaneous degeneration atrioventicular reciprocating tachycardia (AVRT), electrical properties accessory pathway, accessory pathway effects on atrial structure and vulnerability of intrinsic atrial muscle. The location of accessory pathway and also the possibility of a hidden track of accessory pathway that sometimes gives an overview of less obvious delta waves, but does not rule out the WPW syndrome in this case. AF has a significant prognostic in WPW syndrome. This condition can be life-threatening if there is very rapid ventricular response. The use of drugs that slow AV conduction block is not recommended.