Members of the emergency medical team may have difficulty diagnosing rapid atrial fibrillation in Wolff-Parkinson-White syndrome

Koźluk, Edward; Timler, Dariusz; Zyśko, Dorota; Piątkowska, Agnieszka; Grzebieniak, Tomasz; Gajek, Jacek; Gałązkowski, Robert; Fedorowski, Artur

doi:10.5603/cj.a2014.0086

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…Atrial fibrillation (AF) is encountered commonly in the Emergency Department -however, in the presence of a fast-conducting antegrade accessory pathway, it becomes a life-threatening arrhythmia making early recognition vital. In a survey study, only 18% of emergency physicians surveyed identified WPW and less than 10% correctly identified AF 6 -we hope our picture quiz highlights this rarely encountered but potentially fatal arrhythmia.…”

Section: Discussionmentioning

confidence: 87%

Shock first, ask questions later…

Brown¹,

Jackson²

2022

Acute Med

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A 39-year-old man presented to the Emergency Department following a sudden onset of palpitations an hour earlier. He was clammy and felt generally unwell. He was normally fit and active with no history of cardiac symptoms including palpitations – he mentioned as a teenager he was told that he had an ‘extra bit of wiring in his heart’ but nothing further was done. His only regular medication was Sertraline. He drank alcohol to excess. On examination, he was hypotensive but pain free. Bloods including potassium and magnesium were within normal limits – venous lactate was mildly elevated at 2.8. His ECG can be seen in Figure 1A

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Section: Discussionmentioning

confidence: 87%

Shock first, ask questions later…

Brown¹,

Jackson²

2022

Acute Med

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“…Indeed, in a survey study of emergency medicine physicians, this challenging tachyarrhythmia was identified as WPW syndrome by only 18% of responders, while less than 10% of participants identified AF. 2 …”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation in a Patient With an Accessory Pathway

Silverman

Taneja

Benchetrit

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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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.

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“…In fact, it can be generally stated that atrial fibrillation with WPW is often not diagnosed correctly and should therefore be avoided. In the case of further training, these cases should be addressed [28].…”

Section: Af and Wpw Syndromementioning

confidence: 99%