Catheter ablation of the accessory pathway is an effective treatment for pre-excited atrial fibrillation in patients with concurrent rheumatic mitral stenosis and WPW syndrome.
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Supports ablation feasibility in pre-excited AF with rheumatic mitral stenosis and WPW; leaves open need for prospective confirmation.
Rheumatic mitral stenosis (MS) is an acquired valvular condition and is rarely associated with Wolff-Parkinson-White (WPW) syndrome. A 51-year-old Caucasian female with known MS presented with syncopal episodes, exertional fatigue and was noted to have atrial fi brillation (AF) with wide-QRS complexes. Old electrocardiogram revealed classical fi ndings of WPW syndrome and wide-QRS was believed to be due to pre-excited AF. Transthoracic echocardiogram demonstrated moderate MS and preserved systolic function. Electrophysiological studies revealed left anterolateral accessory pathway (AP) that was successfully ablated. Pre-excited AF manifests as cardiomyopathy, hemodynamic compromise, multiorgan dysfunction, and ventricular fi brillation. Catheter ablation of AP with or without restoration of sinus rhythm is the recommended therapy, with mitral valve replacement in the same or subsequent procedure.
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Vallabhajosyula et al. (2014) studied this question.
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