WOLFF PARKINSON and WHITE (WPW) syndrome is the most common form of pre-excitation. It is associated in some cases with atrial fibrillation with a high risk of sudden death. We report the case of a 64-year-old hypertensive woman with a history of ischemic stroke. She presented with hyperkinetic palpitations without hemodynamics instability on admission. The？electrocardiogram recorded a complete tachyarrhythmia by pre-excitation atrial fibrillation, with a mean rate of 300 beats per minute. Electrophysiological investigation revealed an accessory pathway located at the ostium of the coronary sinus, which was successfully ablated by radiofrequency. A drug？treatment based on flecaine 100？mg was introduced. The patient was asymptomatic after one month of outpatient follow-up.
References
[1]
Brugada, J., Katritsis, D.G., Arbelo, E., et al. (2020) 2019 ESC Guidelines for the Management of Patients with Supraventricular Tachycardia. The Task Force for the Management of Patients with Supraventricular Tachycardia of the European Society of Cardiology (ESC). European Heart Journal, 41, 655-720.
https://doi.org/10.1093/eurheartj/ehz467
[2]
Bhatia, A., Sra, J. and Akhtar, M. (2016) Preexcitation Syndromes. Current Problems in Cardiology, 41, 99-137. https://doi.org/10.1016/j.cpcardiol.2015.11.002
[3]
Page, R.L., Joglar, J.A., Caldwell, M.A., et al. (2016) 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation, 133, e471-505.
[4]
Skov, M.W., Rasmussen, P.V., Ghouse, J., et al. (2017) Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results from the Copenhagen ECG Study. Circ: Arrhythmia and Electrophysiology, 10, e004778.
https://doi.org/10.1161/CIRCEP.116.004778
[5]
Al-Khatib, S.M., Arshad, A., Balk, E.M., et al. (2016) Risk Stratification for Arrhythmic Events in Patients with Asymptomatic Pre-Excitation: A Systematic Review for the 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation, 133, e575-e586.
https://doi.org/10.1161/CIR.0000000000000309
[6]
Gemma, L.W., Steinberg, L.A., Prystowsky, E.N., et al. (2013) Development of Rapid Preexcited Ventricular Response to Atrial Fibrillation in a Patient with Intermittent Preexcitation. Journal of Cardiovascular Electrophysiology, 24, 347-350.
https://doi.org/10.1111/j.1540-8167.2012.02398.x
[7]
Morady, F., Dicarlo, L.A., Baerman, J.M., et al. (1987) Effect of Propranolol on Ventricular Rate during Atrial Fibrillation in the Wolff-Parkinson-White Syndrome. Pacing and Clinical Electrophysiology, 10, 492-497.
https://doi.org/10.1111/j.1540-8159.1987.tb04511.x
[8]
Sellers, T.D., Bashore, T.M. and Gallagher, J.J. (1977) Digitalis in the Pre-Excitation Syndrome. Analysis during Atrial Fibrillation. Circulation, 56, 260-267.
https://doi.org/10.1161/01.CIR.56.2.260
[9]
Boriani, G., Biffi, M., Frabetti, L., et al. (1996) Ventricular Fibrillation after Intravenous Amiodarone in Wolff-Parkinson-White Syndrome with Atrial Fibrillation. American Heart Journal, 131, 1214-1216.
https://doi.org/10.1016/S0002-8703(96)90098-8
[10]
Tijunelis, M.A. and Herbert, M.E. (2005) Myth: Intravenous Amiodarone Is Safe in Patients with Atrial Fibrillation and Wolff-Parkinson-White Syndrome in the Emergency Department. Canadian Journal of Emergency Medicine, 7, 262-265.
https://doi.org/10.1017/S148180350001441X
[11]
Pappone, C., Vicedomini, G., Manguso, F., et al. (2014) Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation: Insights from a Registry Study of 2169 Patients. Circulation, 130, 811-819.
https://doi.org/10.1161/CIRCULATIONAHA.114.011154
[12]
Wongcharoen, W., Lin, Y.-J., Chung, F.-P., et al. (2018) Radiofrequency Ablation of Accessory Pathways in Patients with the Wolff-Parkinson-White Syndrome: Long-Term Risk of Mortality and Coronary Events. EP Europace, 20, 1035-1042.
https://doi.org/10.1093/europace/eux115
[13]
Centurion, O.A. (2011) Atrial Fibrillation in the Wolff-Parkinson-White Syndrome. Journal of Atrial Fibrillation, 4, 287.
