A 46-year-old man with Wolff-Parkinson-White syndrome developed pre-excited atrial fibrillation with ventricular rates exceeding 280 beats per minute following thoracic surgery.
Case Report (n=1)
This teaching case highlights the electrocardiographic features of pre-excited atrial fibrillation in Wolff-Parkinson-White syndrome and emphasizes evidence-based management strategies that avoid atrioventricular nodal blockade.
Wolff-Parkinson-White syndrome, though previously diagnosed and without prior arrhythmic events, may remain clinically quiescent until atrial fibrillation with rapid antegrade conduction over an accessory pathway precipitates a potentially life threatening arrhythmia. We present a teaching case of a 46-year-old man who developed abrupt onset wide-complex tachycardia with ventricular rates exceeding 280 beats per minute on postoperative day three following thoracic surgery. Electrocardiography demonstrated an irregularly irregular rhythm with marked beat-to beat QRS variability and very short RR intervals, favoring atrial fibrillation with preexcitation rather than ventricular tachycardia or rate-related aberrancy. This case is used to illustrate key electrocardiographic features that distinguish pre-excited atrial fibrillation from other causes of wide-complex tachycardia and to review evidence based management principles in hemodynamically stable patients, including the selection of therapies that target accessory pathway conduction while avoiding atrioventricular nodal blockade.
Lemieux et al. (Wed,) conducted a case report in Wolff-Parkinson-White syndrome with pre-excited atrial fibrillation (n=1). A 46-year-old man with Wolff-Parkinson-White syndrome developed pre-excited atrial fibrillation with ventricular rates exceeding 280 beats per minute following thoracic surgery.