Cor Vasa 2014, 56(5):e427-e432 | DOI: 10.1016/j.crvasa.2014.03.002

Potentially misleading manifestation of a ventricular pre-excitation

Jiřina Hurychová^a,*, Luděk Haman^b

^a Department of Cardiology, Prince Philip Hospital Llanelli, Hywel Dda University Health Board, Velká Británie

^b I. interní kardioangiologická klinika, Lékařská fakulta Univerzity Karlovy v Hradci Králové a Fakultní nemocnice Hradec Králové, Hradec Králové, Česká republika

We present the case report of a 56-year-old man with an unusual manifestation of an accessory pathway. Failure to detect, or incorrect diagnosis, of this anomaly could have put the patient at high risk of sudden cardiac death. The accessory pathway described in this case report was located at the left posteroseptal area and presented initially with a broad QRS complex tachycardia. Despite being pre-excited atrial fibrillation, it could have been misinterpreted as ventricular tachycardia. Once the rhythm had changed to sinus, a Q-wave in the inferior ECG leads became apparent. This finding could have been misdiagnosed as an old myocardial infarction and treated as such, including prescription of betablockers which might, in theory, increase the risk of sudden cardiac death. The treatment of choice for the patient was radiofrequency ablation of the accessory pathway.

Keywords: Accessory pathway; AVRT; Broad complex tachycardia; Pre-excited atrial fibrillation; Sudden cardiac death

Received: January 19, 2014; Revised: March 16, 2014; Accepted: March 18, 2014; Published: October 1, 2014  Show citation