Myocardial infarction in Wolff-Parkinson-White syndrome

Abstract

The electrocardiographic confirmation of myocardial infarction in the presence of the Wolff-Parkinson-White syndrome has been difficult to obtain. 5,6,10 The bundle branch block configuration, it is maintained, will obscure the pattern of myocardial necrosis. The purpose of this paper is to present a case where the electrocardiogram was diagnostic of infarction in the presence of anomalous atrioventricular conduction. This individual was known to have had the Wolff-Parkinson-White syndrome for at least five years before the onset of a classical clinical episode of acute myocardial infarction. Fortuitously, in one of the tracings a spontaneous change occurred from anomalous atrioventricular excitation to periods of normal conduction. It was during these latter phases that unequivocal electrocardiographic evidence of myocardial infarction was noted. No case with a similar electrocardiographic pattern has been found in a thorough search of the literature. The syndrome of short P-R interval and prolonged QRS complex was first defined as a clinical entity by Wolff, Parkinson, and White 1 in 1930. Wolferth and Wood 2 and Holzmann and Scherf 3 independently postulated the existence of an accessory pathway between the atria and ventricles, similar to the so-called bundle of Kent, as explaining the electrocardiographic findings. Originally, Wolff, Parkinson, and White believed they were dealing with the effect of excessive vagal tone. There have been others 4 who offered evidence that the syndrome had a physiologic basis. This syndrome has been considered benign except for the attendant dangers of recurring attacks of paroxysmal tachycardia.