Key result
An electrophysiological study successfully identified and ablated a left-sided accessory atrioventricular pathway in a 22-year-old male with wide complex tachycardia and multiple ICD shocks.
Why the study?
Wide complex tachycardia associated with syncope can indicate life-threatening arrhythmia, making identification of its aetiology imperative to provide appropriate treatment and prevent recurrence.
Case Report (n=1)
In young patients without structural heart disease experiencing wide complex tachycardia, an EP study should be offered before ICD implantation to identify and potentially cure underlying conditions like Wolff-Parkinson-White syndrome.
May support considering EP study before ICD in young patients with wide complex tachycardia; hypothesis-generating for broader adoption.
BACKGROUND: Wide complex tachycardia (WCT) associated with syncope as manifestation of an underlying, life-threatening arrhythmia might potentially be the harbinger of sudden cardiac death. Identifying the aetiology of a WCT is imperative to provide appropriate treatment and prevent recurrence. CASE SUMMARY: We report the case of a 22-year-old male who had been experiencing haemodynamically significant WCT leading to syncope at the age of 13 years. As the patient and the family rejected an electrophysiological (EP) study, he had received an implantable cardioverter-defibrillator (ICD) for secondary prevention. After 7 years of experiencing multiple shocks, the patient finally gave consent to an EP study, which identified a left-sided accessory atrioventricular pathway that was successfully ablated during the same procedure. DISCUSSION: The differential diagnosis of WCT might be challenging and includes both ventricular and supraventricular tachycardias. In young patients without structural heart disease experiencing WCT, an EP study should be offered before ICD implantation to make a final diagnosis with the potential to provide definitive treatment.
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Preisendörfer et al. (2021) conducted a case report in Wide complex tachycardia due to Wolff-Parkinson-White syndrome (n=1). Electrophysiological (EP) study and ablation was evaluated on Identification and ablation of accessory pathway. An electrophysiological study successfully identified and ablated a left-sided accessory atrioventricular pathway in a 22-year-old male with wide complex tachycardia and multiple ICD shocks.
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