Open AccessA case of wide complex tachycardia in wolff-parkinson-white syndrome
Author(s) -
Jonathan Lowenthal,
Jack Xu,
Eric Pagan,
Richard Tangel,
Daniel Schaer,
Theodore Maglione,
Amardeep Saluja
Publication year - 2019
Publication title -
case reports in internal medicine
Language(s) - English
Resource type - Journals
eISSN - 2332-7251
pISSN - 2332-7243
DOI - 10.5430/crim.v6n4p1
Subject(s) - medicine , atrial flutter , cardiology , tachycardia , sinus rhythm , accessory pathway , wpw syndrome , electrophysiology study , electrocardiography , qrs complex , cardioversion , anesthesia , atrial fibrillation , catheter ablation
The manifestation of atrial flutter, particularly with 1:1 conduction, is rare in patients with ventricular preexcitation secondary to Wolff-Parkinson-White Syndrome (WPW). Very few cases have been reported in the literature. We present a 40-year old male with a history of untreated WPW who presented with severe chest pain and shortness of breath. He was found to have a rapid, regular, wide complex tachycardia. He underwent successful synchronized cardioversion, in which the patient converted tonormal sinus rhythm with classic WPW waveform characteristics, including a shortened PR interval and prolonged QRS complex with a slurred upstroke. Surprisingly, a subsequent electrophysiology study revealed atrial flutter, with bystander conduction of 1:1 atrial flutter being the most likely cause of the patient’s presenting symptoms, and a posteroseptal accessory pathway consistent with the diagnosis of WPW. While considerably rarer than ventricular tachycardia or AVRT, it is nevertheless important for clinicians to consider atrial flutter with 1:1 conduction as a potential diagnosis in patients with WPW presenting with wide complex tachycardia.