Highlights that patients with manifest WPW syndrome may have an underlying arrhythmogenic substrate associated with early repolarization that is masked by ventricular preexcitation.
Should not change WPW ablation practice; hypothesis-generating for unmasked early repolarization requiring prospective confirmation.
We encountered a 39-year-old man with documented ventricular fibrillation (VF). His ECGs showed intermittent Wolff-Parkinson-White (WPW) syndrome pattern. During electrophysiological study, no ventricular preexcitation was observed. An accessory pathway located at the posterior mitral annulus was identified, and successfully eliminated by radiofrequency catheter ablation. VF was not induced. His ECGs in the absence of delta waves demonstrated early repolarization in the inferior leads. This case raises the possibility that patients with manifest WPW syndrome may have an arrhythmogenic substrate associated with early repolarization, and the characteristic J waves can be masked by the presence of ventricular preexcitation.
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Takahashi et al. (2012) studied this question.
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