An esophageal lead was used to perform decremental atrial pacing and elective induction of atrial fibrillation (AF) in 5 patients with the Wolff-Parkinson-White (W-P-W) syndrome before and after amiodarone therapy. In the control state, 1:1 atrioventricular (AV) conduction over the accessory pathway ranged from 220 to 260 ms (mean 232). The shortest R-R interval during AF ranged from 190 to 210 ms (mean 198). The ventricular rate ranged from 175 to 212 beats/min (mean 196). After amiodarone therapy, the shortest cycle length with 1:1 AV conduction increased in all patients, ranging from 290 to 540 ms (mean 370); during AF, no preexcited beat was present in 2 patients, whereas the minimal preexcited R-R interval in the remaining 3 was 290, 240, and 370 ms, respectively. The ventricular response during AF decreased in all patients. Thus, esophageal pacing is a useful method for identifying patients at risk with the W-P-W syndrome and for assessing appropriate management in individual patients. Amiodarone provides protection against life-threatening arrhythmias in these patients.