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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Main Authors: Andrew Silverman ScB, Sonia Taneja BA, MSc, Liliya Benchetrit BS, Peter Makusha BA, Robert L. McNamara MD, MHS, Alexander B. Pine MD, PhD
Format: Article
Language:English
Published: SAGE Publishing 2018-09-01
Series:Journal of Investigative Medicine High Impact Case Reports
Online Access:https://doi.org/10.1177/2324709618802870
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spelling 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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