Electrocardiographic abnormalities in a patient with pre-excitation and acute myocardial infarction undergoing percutaneous coronary intervention and ablation

Abstract

Pre-excitation syndrome can either mimic or mask myocardial infarction, making the diagnosis of acute myocardial infarction difficult. Herein, we report the case of a male patient with Wolf-Parkinson-White (WPW) syndrome who presented to our emergency department with severe chest pain. Non-ST-elevation myocardial infarction was suspected because of cardiac enzyme elevation and abnormal ST-T changes identified through electrocardiography. The patient underwent percutaneous coronary intervention; a left anterior descending artery stenotic lesion was dilated, and drug-eluting stents were implanted. One month later, he underwent successful radiofrequency catheter ablation for his accessory pathway and tachycardia. We present the series of electrocardiographic ST-T abnormalities to raise awareness of the value of diagnosing myocardial injury early in patients with WPW syndrome.

Differentiating between Exercise-Induced ST-Segment Abnormalities Secondary to Wolff-Parkinson-White (WPW) Syndrome and Acute Myocardial Infarction

“…ECG features of primary ST-T wave changes are as follows: concordant or discordant with the delta wave vector, horizontal depression, symmetrical T-wave inversion, and ST-T changes in 2 or more contiguous leads in the presence of clinical ischemic symptoms. 1 Initial identifi cation based on clinical characteristics and PTP risk scoring is crucial for distinguishing the cause of these wave changes. A PTP risk score <15% shows a low likelihood of CAD and further investigation is either unnecessary or deffered.…”

“…The abnormal activation sequence through electrocardiography (ECG) may mimic the characteristic features of MI. 1 ST-elevation in aVR during narrow QRS complex tachycardia suggests atrioventricular reentry through an accessory pathway (AP). 2 Conversely, this phenomenon during EST increases the likelihood of having left main (LM) or ostial left anterior descending (LAD) stenosis.…”

Masked ECG Changes in Wolff-Parkinson-White Syndrome Coexisting With Myocardial Infarction: A Case Report

“…The patient had a successful percutaneous coronary intervention and radiofrequency catheter ablation for his accessory pathway. This case shows the importance of serial biomarkers in diagnosing MI in WPW [ 11 ].…”