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June 28, 2022European Heart Journal - Case ReportsOpen Access

Atrioventricular 2:1-conduction via an accessory pathway during left atrial flutter unmasking WPW syndrome: a case report

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Why the study?

Accurate diagnostic workup of broad complex tachycardia is crucial to ensure correct indication for ICD treatment and to avoid unnecessary invasive treatment and device-associated morbidity.

Population

One 72-year-old patient with regular broad complex tachycardia

Design

Case report

Authors

MHMoritz Till HuttelmaierJHJonas HertingTFThomas H. Fischer

Discussion

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Overview

Accurate broad complex tachycardia workup is essential to avoid inappropriate ICDs; this case leaves open whether routine EP study refines indications in WPW variants.

Structured PICO

P
Population
72-year-old patient presenting with regular broad complex tachycardia with superior axis and positive concordance in precordial leads, later diagnosed with atypical atrial flutter with 2:1 AV conduction via a left-posterior accessory pathway (WPW syndrome).
I
Intervention
Invasive electrophysiological study and ablation of the left-posterior accessory pathway.
O
Outcome
Diagnosis and successful ablation of the accessory pathway.

The absence of classic ECG criteria for preexcitation syndrome does not rule out an accessory pathway, highlighting the importance of accurate diagnostic workup of broad complex tachycardia to avoid unnecessary ICD implantation.

Cite This Study

Huttelmaier et al. (2022) studied this question.

synapsesocial.com/papers/6a9690c2c00de92d9bfbc1f4https://doi.org/10.1093/ehjcr/ytac250
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A case of wide complex tachycardia in wolff-parkinson-white syndrome2019
  2. 2Irregular wide QRS complex tachycardia without structural heart disease2012 · 1 citations
  3. 3Wide QRS complex tachycardia with a mysterious mask—Tricuspid isthmus‐dependent atrial flutter with preexcitation syndrome and dual atrioventricular nodal pathway conduction2023 · 1 citations
  4. 4What is the mechanism of this narrow QRS tachycardia in a patient with type‐A Wolff‐Parkinson‐White (WPW) syndrome?2024
  5. 5Amiodarone Induced Ventricular Fibrillation in Unveiled WPW Syndrome2026