Wolff-Parkinson-White Syndrome in Congenital Rubella Syndrome

Abstract

To the Editor: A 13-y-old girl presented with poor vision in both eyes and absent hearing since birth. She had undergone cataract surgery in both eyes at the age of 7 mo. Serology titres done at the time of cataract surgery were positive for rubella IgG (351 IU/mL). Ocular examination revealed microcornea and aphakia with secondary glaucoma. She was suspected to have congenital rubella syndrome and underwent a cardiac evaluation. Electrocardiography showed shortened PR interval with slurring and slow rise of the initial upstroke of QRS complex (delta waves) suggestive of Wolff-Parkinson-White (WPW) syndrome (Fig. 1). Echocardiography showed no structural anomaly. She underwent a tube-shunt surgery for glaucoma in both eyes under general anesthesia. She did not require any intervention for her tachyarrhythmia as she was asymptomatic and was identified at a low risk for cardiac arrest. Rubella virus is the most common infectious teratogen causing several structural heart defects [1]. WPW syndrome has been rarely described in association with congenital rubella in a single case by Way RC [2]. Ebstein’s anomaly has been reported as a rare finding in congenital rubella syndrome which is commonly associated with accessory conduction pathways like WPW syndrome [3, 4]. However, our patient did not have an underlying Ebstein’s anomaly as confirmed by echocardiography. Rubella myocarditis has been described previously and known to heal completely in-uterocausingonly electrocardiographic changes. Hence, the precise mechanism for occurrence of WPW syndrome in congenital rubella infection is not certain. It remains to be determined whether this conduction defect is related to the rubella syndrome or a mere co-incidence as the prevalence of this ventricular preexcitation is thought to be 0.1–0.2 % in the general population [5]. It is plausible that structural or mutational changes caused by the rubella virus may result in anomalous embryonic development of myocardial tissue explaining this rare co-occurrence. In patients with WPW syndrome, there is a high risk of paroxysmal tachyarrhythmia during anesthesia. Preoperative sedation and analgesia in addition to antiarrhythmic drugs and defibrillator may prevent such complications.