Key result
Catheter ablation successfully eliminates arrhythmia recurrence at 3 months in pre-excited AF case.
Why the study?
Minimal preexcitation presenting with preexcited atrial fibrillation as the first manifestation is rare and its risk implications are unclear.
Case Report (n=1)
This case highlights that minimal baseline pre-excitation on an ECG does not indicate a low risk of potentially life-threatening pre-excited atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Alerts clinicians against assuming low risk from minimal WPW pre-excitation; single case leaves open need for prospective validation.
Introduction: A 46-year-old Thai woman presented with palpitation. A 12-lead electrocardiogram (ECG) showed rapid rate of preexcited atrial fibrillation (AF). The subsequent ECG after electrical cardioversion demonstrated minimal preexcitation with short PR interval, and apparently small delta waves only in leads II, III, V4, and V5. An electrophysiologic study was performed and showed sinus rhythm with short H-V interval compatible with preexcitation. A programmed electrical stimulation showed orthodromic atrioventricular reentrant tachycardia utilizing left lateral accessory pathway. The catheter ablation was successfully performed via retrograde aortic approach to left lateral accessory pathway. There was no recurrence of Wolff-Parkinson-White (WPW) ECG pattern, supraventricular tachycardia, or AF during 3-month follow-up visit. Conclusion: This is a rare case of minimal preexcitation presenting with preexcited AF as first presentation. This case reflects minimal preexcitation does not indicate low risk of ventricular fibrillation and sudden cardiac arrest.
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Komsing Methavigul (2026) conducted a case report in Pre-excited atrial fibrillation with minimal pre-excitation (n=1). Catheter ablation via retrograde aortic approach was evaluated on Recurrence of Wolff-Parkinson-White (WPW) ECG pattern, supraventricular tachycardia, or atrial fibrillation. Catheter ablation successfully prevented recurrence of WPW pattern, SVT, and atrial fibrillation at 3 months in a woman with minimal pre-excitation presenting with pre-excited AF.
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