Atrial Fibrillation in a Patient With an Accessory Pathway
A 24-year-old man with history of unspecified arrhythmia presented with palpitations and chest pain. Initial electrocardiogram (ECG) revealed irregular tachycardia with varying QRS width: 150 to 200 beats per minute for narrow complexes and 300 beats per minute for wide complexes. Following cardiove...
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doaj-0516274d19ed44fbb274c9dd91851fb12020-11-25T03:40:00ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962018-09-01610.1177/2324709618802870Atrial Fibrillation in a Patient With an Accessory PathwayAndrew Silverman ScB0Sonia Taneja BA, MSc1Liliya Benchetrit BS2Peter Makusha BA3Robert L. McNamara MD, MHS4Alexander B. Pine MD, PhD5Yale University, New Haven, CT, USAYale University, New Haven, CT, USAYale University, New Haven, CT, USAYale University, New Haven, CT, USAYale University, New Haven, CT, USAYale University, New Haven, CT, USAA 24-year-old man with history of unspecified arrhythmia presented with palpitations and chest pain. Initial electrocardiogram (ECG) revealed irregular tachycardia with varying QRS width: 150 to 200 beats per minute for narrow complexes and 300 beats per minute for wide complexes. Following cardioversion, ECG revealed sinus tachycardia with a preexcitation pattern of positive delta waves in the anterolateral leads and negative delta waves in inferior leads. The patient remained in sinus rhythm and underwent successful ablation of a right posteroseptal accessory pathway. Subsequent ECG showed upright T waves in the leads I, aVL, and V2-6, large inverted T waves in leads III and aVF, and no delta waves. This case serves as an important reminder that atrial fibrillation (AF) in the presence of an accessory pathway may present with confounding ECG features, potentially leading to incorrect diagnoses and treatments that may be life threatening. Despite 10% to 30% prevalence of AF in the presence of an accessory pathway and the relative awareness of Wolff-Parkinson-White syndrome among general internal medicine providers, the clinical recognition of Wolff-Parkinson-White syndrome may be hindered in the presence of preexcited AF.https://doi.org/10.1177/2324709618802870 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Andrew Silverman ScB Sonia Taneja BA, MSc Liliya Benchetrit BS Peter Makusha BA Robert L. McNamara MD, MHS Alexander B. Pine MD, PhD |
spellingShingle |
Andrew Silverman ScB Sonia Taneja BA, MSc Liliya Benchetrit BS Peter Makusha BA Robert L. McNamara MD, MHS Alexander B. Pine MD, PhD Atrial Fibrillation in a Patient With an Accessory Pathway Journal of Investigative Medicine High Impact Case Reports |
author_facet |
Andrew Silverman ScB Sonia Taneja BA, MSc Liliya Benchetrit BS Peter Makusha BA Robert L. McNamara MD, MHS Alexander B. Pine MD, PhD |
author_sort |
Andrew Silverman ScB |
title |
Atrial Fibrillation in a Patient With an Accessory Pathway |
title_short |
Atrial Fibrillation in a Patient With an Accessory Pathway |
title_full |
Atrial Fibrillation in a Patient With an Accessory Pathway |
title_fullStr |
Atrial Fibrillation in a Patient With an Accessory Pathway |
title_full_unstemmed |
Atrial Fibrillation in a Patient With an Accessory Pathway |
title_sort |
atrial fibrillation in a patient with an accessory pathway |
publisher |
SAGE Publishing |
series |
Journal of Investigative Medicine High Impact Case Reports |
issn |
2324-7096 |
publishDate |
2018-09-01 |
description |
A 24-year-old man with history of unspecified arrhythmia presented with palpitations and chest pain. Initial electrocardiogram (ECG) revealed irregular tachycardia with varying QRS width: 150 to 200 beats per minute for narrow complexes and 300 beats per minute for wide complexes. Following cardioversion, ECG revealed sinus tachycardia with a preexcitation pattern of positive delta waves in the anterolateral leads and negative delta waves in inferior leads. The patient remained in sinus rhythm and underwent successful ablation of a right posteroseptal accessory pathway. Subsequent ECG showed upright T waves in the leads I, aVL, and V2-6, large inverted T waves in leads III and aVF, and no delta waves. This case serves as an important reminder that atrial fibrillation (AF) in the presence of an accessory pathway may present with confounding ECG features, potentially leading to incorrect diagnoses and treatments that may be life threatening. Despite 10% to 30% prevalence of AF in the presence of an accessory pathway and the relative awareness of Wolff-Parkinson-White syndrome among general internal medicine providers, the clinical recognition of Wolff-Parkinson-White syndrome may be hindered in the presence of preexcited AF. |
url |
https://doi.org/10.1177/2324709618802870 |
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