A sword of Damocles in an asymptomatic man presenting with serendipitously detected ventricular pre-excitation

Abstract

MOTS CLES Syndrome de WolfA 25-year-old man was admitted to hospital for electrophysiological studies for WolfParkinson-White syndrome, discovered during a medical clearance examination to be a professional soccer referee. This athlete had no medical history, reported no symptoms and his physical examination was normal. A 12-lead electrocardiogram revealed the presence of ventricular pre-excitation, a negative delta wave in leads I and aVL, and right bundle branch-type QRS morphology, consistent with a left lateral accessory pathway (Fig. 1), which persisted during peak exercise. Electrophysiological studies confirmed the presence of a left lateral accessory pathway and the induction of atrial fibrillation by rapid atrial pacing, immediately followed by the development of ventricular fibrillation (Fig. 2a, b), requiring the delivery of two consecutive biphasic 200J DC shocks to restore sinus rhythm (Fig. 3a). The patient