Pre-excitation Syndrome Unveiling Ebstein Anomaly at an Exceptionally Advanced Age

Figures

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  Figure 1. (A) Electrocardiogram findings at admission: accordion-like morphology with an irregularly irregular wide-complex tachycardia suggestive of pre-excited atrial fibrillation. (B) The electrocardiogram after electrical cardioversion, revealing a shortened PR interval and a negative delta wave in V1, along with a QRS transition occurring before V3 and with the most prominent positive delta wave observed in AVL, which suggests the presence of a right posteroseptal atriofascicular tract.

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  Figure 2. (A, B) Apical 4-chamber view reveals significant apical displacement of the septal tricuspid leaflet (orange arrow) relative to the anterior mitral leaflet (green arrow), leading to atrialization of the right ventricle. (C) Apical 4-chamber view demonstrates pronounced enlargement of the right atrium. (D) Color-flow Doppler shows evidence of severe tricuspid valve regurgitation. (E) Longitudinal systolic function of the right ventricle appears normal based on S′ wave and isovolumic acceleration. (F) Position of catheters during an electrophysiology study. We note the massively enlarged right heart with the displaced tricuspid annulus and the distortion of anatomic landmarks, making the procedure difficult.