C60. Management of Symptomatic Wolff-Parkinson-White (WPW) Syndrome: A Case Report

Abstract

Abstract Background Atrioventricular reentrant tachycardia (AVRT) could be the reentrant tachyarrhythmia that occurs in Wolff-Parkinson-White (WPW) syndrome. In AVRT, the existence of normal AV node and accessory pathway (AP) along with the atria and ventricles establish the electrical circuit that permits impulse re-entry. The incidence of multiple accessory pathways (MAP) is reported 3-15% and incidence of sudden cardiac death (SCD) in WPW syndrome is about 0.25% per year or 3% to 4% over a lifetime. Case Description We presented a case of Wolff-Parkinson-White Syndrome. A 28-year old man was admitted for evaluation of frequent episodes of palpitation. The diagnosis of WPW syndrome was established based on the 12 lead surface electrocardiogram (ECG). Echocardiography showed normal resting echocardiography then we performed electrophysiology study (EPS). We conducted the radiofrequency ablation (RFA) to the accessory pathway (AP). The challenging point of this case was multiple accessory pathways (APs) located at right posteroseptal and left lateral. Discussion Ablation of multiple accessory pathways (MAP) had a longer fluoroscopic time and large number of unsuccessful attempts than those with a single accessory pathway. We performed RFA at right posteroseptal and left lateral accessory pathway. The radiofrequency ablation has successfully eliminated both accessory pathways. In summary, we conclude that anatomical consideration, EP study, and the ablation strategy was important to improve the safety and success rate of RFA procedure.