Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
+44 1300 500008
ISSN: 2155-9880
+44 1300 500008
Phuc Vu, Tai Truyen, Anh Tu Nguyen, Doan Ngoc Chau Nguyen, Nguyen PT Tran, Thao Nguyen, Khiem Ngo, Tuan Phat Nguyen Ngoc Dang Khoa Tran, Phillip Tran
University of Medicine and Pharmacy, Vietnam Tan Tao University- School of Medicine University of Debrecen, Hungary Hue University of Medicine and Pharmacy, Vietnam Danang Family Hospital Pham Ngoc Thach University of Medicine, Vietnam Yavapai Regional Medical Center, USA Nam Can Tho University, Vietnam
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Case presentation: A 20-year-old female with a past medical history of ablated Wolff-Parkinson-White (WPW) presented to the ER with heart palpitation, chest discomfort, and shortness of breath. At admission, her ECG demonstrated a wide complex tachycardia of 300 beats per minute (bpm) with a QRS of 230ms, fusion beat suggesting VT, which self terminated by the time of ECG (Figure 1A). Her vital signs are stable. Her baseline ECG showed a normal sinus rhythm with ventricular pre-excitation/WPW concerning for posteroseptal pathway, 60 bpm, PR 117ms, QRS 130ms, and QTc 412ms (Figure 1B). The patient was referred for an evaluation of ablation. Literature review: Wolff-Parkinson-White syndrome is a clinical condition characterized by arrhythmia symptoms and the pre-excitation sign on ECG, including short PR interval < 120ms, a Delta wave, and QRS complex > 120ms [1]. The WPW prevalence is 2.5 per 1000 [2]. Unique aspects of case: Patients with WPW syndrome could be complicated by severe tachycardia, including AVRT, VF, and VT. In the case of VT defined as an arrhythmia of more than 3 consecutive complexes originating in the ventricles at a rate >100 bpm (cycle length less than 600 ms) [6], DC cardioversion is also the treatment of choice for unstable patients while procainamide can be helpful to terminate VT in stable patients [6]. Electrophysiologic study and ablation are treatments of choice for chronic treatment, with the overall success in curing the accessory pathway being 93% [7]. Medical therapy is more effective in terminating an acute episode of tachycardia than preventing recurrence. Recommendations Conclusion: Wolff-Parkinson-White syndrome could induce lethal tachycardia. VT is rare and could be from Re-entry mechanism or scar from prior incomlete ablation. Acute treatments are DC cardioversion and antiarrhythmic drugs. The long-term treatment of choice is ablation to curing the accessory pathway and prevent the recurrence of WPW.