Case Report: Pre-excited atrial fibrillation as the initial manifestation of Wolff Parkinson White Syndrome

Abstract

BACKGROUND: Atrial fibrillation is the second most common arrhythmia associated with Wolf Parkinson White syndrome. It usually presents itself with high ventricular rates, and its importance lies in the increased risk of turning into ventricular fibrillation and sudden death, which is why an accurate diagnosis is necessary to implement the correct treatment for the acute event and subsequently its definitive resolution. CASE REPORT: A 41-year-old male patient attended the emergency department with a 12-hour evolution clinical course of palpitations and syncope. On arrival, he was hemodynamically stable: an electrocardiogram was performed; with the finding of an irregular rhythm, absence of P waves, wide QRS complexes of variable duration, with the initial phase of the QRS complex wider than the final phase, a heart rate of 160 to 170 beats per minute, with an RR interval of 200 milliseconds, all of this compatible with AF with pre-excitation. CLINICAL COURSE: Due to the high risk of ventricular fibrillation and sudden death, synchronized electrical cardioversion was performed, with which it was possible to revert the sinus rhythm, with the presence of delta waves, compatible with left anterolateral preexcitation. The patient presented a favorable evolution, he was hospitalized and subsequently underwent electrophysiological studies that confirmed the diagnosis of Wolf Parkinson White syndrome, with a left anterolateral Bundle of Kent, which was resolved by radiofrequency ablation. CONCLUSION: A case of atrial fibrillation with pre-excitation as the first manifestation of Wolf Parkinson White syndrome was presented. The treatment of choice in the acute episode is synchronized electrical cardioversion, avoiding the use of drugs that block conduction of the atrioventricular node, due to the increased risk of turning into ventricular fibrillation and sudden death. The definitive treatment in these patients is radiofrequency ablation, it is an effective and safe method.