A BUNDLE IN THE HEART: WOLFF-PARKINSON-WHITE SYNDROME PRESENTING AS CARDIAC ARREST

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Ventricular fibrillation (VF) is a rare complication of Wolff-Parkinson-White (WPW) Syndrome. We present a case of WPW presenting as VF arrest. CASE PRESENTATION: A 21-year-old man with no past medical history was brought to emergency department after he experienced an out of hospital VF cardiac arrest after having a cold slushy. Post arrest electrocardiogram revealed atrial fibrillation with rapid ventricular rate. Patient achieved return of spontaneous circulation after 30 minutes of advanced cardiac life support. Patient was admitted to Intensive Care Unit for post cardiac arrest care which included targeted temperature management. During his hospitalization, elevated troponin and EKG changes in the inferior leads (II, III and aVF) prompted left heart catheterization. No evidence of coronary artery disease was found. Patient was successfully extubated with good neurological status after rewarming. On review of EKG patient was noted to have shortened PR interval and delta waves in the setting of normal sinus rhythm, thus fulfilling the criteria for WPW syndrome. The morphology of delta waves in the inferior leads was noted to be of pseudo-Q waves. Electrophysiology was consulted and patient underwent successful ablation of the left posterolateral accessory pathway. It was hypothesized that he had an acute vasovagal episode in response to the cold slushy which lead to conduction of atrial fibrillation through accessory pathway into ventricular fibrillation. EKG (figure 1) showing pseudo Q waves in leads II, III and aVF which represent Delta waves. Pathognomic Delta waves seen in precordial leads. DISCUSSION: WPW is a pre-excitation syndrome involving an accessory pathway called bundle of kent. AV nodal blockade in the setting of atrial fibrillation in patients with WPW syndrome leads to pre-excitation of ventricles which can induce ventricular arrythmias. Therefore drugs or conditions leading to AV nodal blockade should be avoided in patients with WPW syndrome as ventricular arrythmias are associated with high morbidity and mortality. CONCLUSIONS: VF accounts for many sudden cardiac deaths (SCD) in WPW syndrome. SCD is more common in patients symptomatic with WPW. AV nodal blockade should be avoided in patients with WPW syndrome. Guidelines and treatment strategies need to be established to screen patients for WPW syndrome. Reference #1: Centurion OA. Atrial Fibrillation in the Wolff-Parkinson-White Syndrome. J Atr Fibrillation. 2011;4(1):287. Published 2011 May 4. https://doi.org/10.4022/jafib.287 DISCLOSURES: No relevant relationships by Anandbir Bath, source=Web Response No relevant relationships by Syed Sami Haider, source=Web Response