Pre-Excited Atrial Fibrillation in a Young Woman with Wolff–Parkinson–White Syndrome Managed with Catheter Ablation Abroad and Followed in a Low-Resource Setting: A Case Report from Somalia

Background: Wolff-Parkinson-White is a cardiac pre-excitation disease linked to a greater incidence of tachyarrhythmias. The occurrence of pre-excited Atrial Fibrillation (AF) represents a life-threatening condition due to rapid conduction over an accessory pathway, which can also result in ventricular fibrillation and unexpected cardiac death. Management requires prompt recognition and definitive treatment with Catheter ablation, which may not be readily available in low-resource settings. Case Presentation: We present the case of a 25-year-old woman with a long history of dizziness throughout childhood, who developed worsening symptoms over three years, including recurrent episodes of syncope. Baseline electrocardiography a sinus rhythm characterized by a shortened PR interval and delta waves consistent with WPW. During symptomatic episodes, electrocardiographic findings exhibited an abnormal, wide-complex tachycardia suggestive of pre-excited AF. A 24-hour Holter monitor confirmed intermittent tachyarrhythmia with persistent pre-excitation. Due to limited local resources, the patient underwent an electrophysiological study abroad, which identified a right lateral accessory pathway. Successful radiofrequency ablation was performed, resulting in the disappearance of pre-excitation. On follow-up in our center, the patient remained asymptomatic, with no return of arrhythmia. Conclusion: This particular case underlines the significance of early identification of pre-excited atrial fibrillation in Wolff-Parkinson-White syndrome and the critical role of catheter ablation as a curative therapy. It also underscores the challenges faced in resource-constrained environments, where access to electrophysiological services is limited, necessitating referral abroad. Strengthening local capacity for advanced cardiac care is essential to improve outcomes in such high-risk patients.