Wolff-Parkinson-White Syndrome and sudden death

Abstract

ABSTRACT Wolff-Parkinson-White (WPW) is the most common syndrome of pre-excitation, which is characterized by premature ventricular depolarization during the conduction of electrical stimulation from the atrium to the ventricle, through one or more extra conduction pathways. This syndrome is considered a risk factor for atrial fibrillation (AF) and tachycardia with broad QRS. Case: male, 26 years old, driver. Acute onset (three hours ago) of increased heart rate associated with general malaise, dizziness with visual disturbance, sweating, shortness of breath and chest discomfort while he was working. Non-smoker, don’t drink alcohol and denies doing drugs. He denies either Diabetes or hypertension, and dislipidemy as well. Denies sudden death episodes among his relatives. Physical examination: sleepiness, slightly dyspneic, irregular heart rhythm with tachycardia, filiform pulse, HR = 180 bpm, BP = 80 x 50 mmHg, lungs without rales. An electrical cardioversion to sinus rhythm was done. Electrocardiogram (ECG) on 12/15/2008: pre-excited AF (broad QRS and irregular RR interval) with high ventricular response and risk of degeneration to VF and sudden death. ECG (12/19/2008): supraventricular tachycardia with narrow QRS and regular RR interval - orthodromic reentrant tachycardia reverted with adenosine 12 mg IV and another ECG was performed, demonstrating sinus rhythm with short PR interval and the presence of delta wave (Wolff-Parkinson-White). The patient was referred for electrophysiological study and a radiofrequency ablation of posteroseptal accessory pathway was successfully, with the disappearance of the delta wave on ECG; thus, was considered cured, asymptomatic and didn’t need medication. The invasive cardiac electrophysiology has provided enhances in our understanding of arrhythmogenic mechanisms and a safe and definite therapy, with clear improvements in the quality of life of patients and, in the case aforementioned, eliminated the risk of sudden death.