Preexcited atrial fibrillation in Wolff-Parkinson-White syndrome; radiofrequency ablation. Case report.

Abstract

Introduction: Wolff-Parkinson-White Syndrome (WPW) is given by atrioventricular re-entry arrhythmias due to existing abnormal conduction pathways. Atrial Fibrillation (AF) in the presence of accessory pathways takes especial interest owing the involved risk in this group of patients, which lack of physiological delay in the normal system of conduction, giving rise to 1:1 conduction from atrial fibrillation. Case Description: 22 years-old male patient, with no drug abuse or familiar cardiomyopathy but previous history of exercise-related palpitations attacks that relief at resting; presented at emergency room because of a syncope onset preceded by prodromal symptoms during sports. At admission, electrocardiogram (EKG) showed wide complex irregular tachycardia at 240 bpm (beats per minute) hemodynamically unstable given by low blood pressure and peripheral hypoperfusion signs. Asynchronous cardioversion was performed with sinus rhythm recovering after a 200 joules discharge. EKG control displayed a short PR interval and delta wave compatible with left lateral accessory pathway, making diagnose of WPW syndrome, and atrial fibrillation as cause of tachycardia. Setting out a high-risk accessory pathway, it was proceeded to perform electrophysiological study plus successful ablation by radiofrequency, with no subsequent arrhythmias and restoring basal EKG. Conclusion: it is fundamental to perform EKG screening tests in every young athletic patient especially on those who present cardiovascular complaints.