Amiodarone Induced Ventricular Fibrillation in Unveiled WPW Syndrome

Figures

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  Figure 1. Antidromic Wide-Complex AVRT on Presentation The 12-lead electrocardiogram obtained at admission demonstrates a wide-complex tachycardia consistent with antidromic atrioventricular reentrant tachycardia (AVRT). Positive delta-wave polarity in lead I and a dominant R delta in lead V1 indicate a left-sided accessory pathway, while negative delta-wave polarity in lead aVF further localizes the pathway to a left posterior or left posterolateral region.

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  Figure 2. Chest Radiograph Anteroposterior chest X-ray demonstrates normal cardiac silhouette and pulmonary vasculature without evidence of congestion or infiltrates.

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  Figure 3. Atrial Fibrillation in Wolff-Parkinson-White Syndrome This electrocardiogram demonstrates an irregularly irregular rhythm with wide and morphologically variable QRS complexes, characteristic of preexcited atrial fibrillation. Notably, several R-R intervals between preexcitation signals are ≤250 milliseconds, indicating a high risk for degeneration into ventricular fibrillation. The findings highlight the urgency for prompt recognition and management in patients with Wolff-Parkinson-White syndrome presenting with atrial fibrillation.

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  Figure 4. Post-ROSC ECG in Wolff-Parkinson-White Syndrome Sinus rhythm is restored after defibrillation. Ventricular preexcitation is evident, with positive delta waves in leads V1–V2 and lead I, indicating a left-sided accessory pathway. The delta-wave polarity in lead aVF (isoelectric to slightly negative) further localizes the pathway to a left posterior or left posterolateral region. ROSC = return of spontaneous circulation.

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  Figure 5. Electrocardiogram 2 Hours Post-ROSC The electrocardiogram obtained 2 hours after return of spontaneous circulation demonstrates persistence of the same preexcitation pattern observed immediately post-defibrillation, with unchanged sinus rhythm and accessory pathway features. Abbreviation as in Figure 4.

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  Figure 6. Postablation 12-Lead Electrocardiogram Demonstrated Sinus Rhythm With Complete Resolution of Ventricular Preexcitation, Consistent With Successful Radiofrequency Catheter Ablation of a Left Lateral Accessory Pathway in Wolff-Parkinson-White Syndrome ECG = electrocardiogram.

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  Figure 7. Algorithm for the Acute Management of Patients Presenting With Wide-Complex Tachycardia in the Absence of an Established Diagnosis4 i.v. = intravenous; other abbreviation as in Figure 6.