Preexcitation Syndrome Presented with Ventricular Tachycardia - A Case Report

Abstract

An adult unconscious patient was brought to intensive care unit (ICU) with impalpable peripheral pulse, non-recordable blood pressure (BP), gross pallor, cyanosis, sweating and gasping respiration along with very rapid and feeble carotid pulse. It revealed ventricular tachycardia on monitor and was revived successfully by immediate direct current (DC) cardioversion along with other resuscitative measures. There was no contributory past history. Subsequent electrocardiogram (ECG) on sinus rhythm was diagnosed as Wolff-Parkinson-White (WPW) syndrome, the most prominent manifestation of preexcitation syndrome, in which the most common tachyarrhythmia is atrio-ventricular reciprocating tachycardia (AVRT). It is classified as orthodromic (more common) or antidromic (less common). Antidromic AVRT is difficult to distinguish from ventricular tachycardia on ECG. Atrial flutter and fibrillation are less common but potentially more serious because they can result in rapid ventricular response rates and, in rare instances, ventricular fibrillation. However, any sustained symptomatic tachyarrhythmia warrants urgent resuscitative electrical and pharmacological maneuver and interventions to restore life, regarding which the health care providers should always remain familiar and updated by Continuing Medical Education (CME). Key words: Wolff-Parkinson-White syndrome, tachyzrrhythmia, preexicitation syndrome. DOI: 10.3329/jafmc.v5i2.4585 JAFMC Bangladesh Vol.5(2) (December) 2009, pp.46-48