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Concomitant Wolff-Parkinson-White and Atrioventricular Nodal Reentrant Tachycardia: Which Pathway to Ablate?

Sinan Sarsam, Ibrahim Sidiqi, Dipak Shah, Marcel Zughaib

(Department of Cardiology, Providence Hospital and Medical Center, Southfield, MI, USA)

Am J Case Rep 2015; 16:872-875

DOI: 10.12659/AJCR.894647

Published: 2015-12-11

BACKGROUND: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of supraventricular tachycardia. In contrast, Wolff-Parkinson-White (WPW) pattern consists of an accessory pathway, which may result in the development of ventricular arrhythmias. Frequent tachycardia caused by AVNRT and accessory pathways may play a role in left ventricular systolic dysfunction.
CASE REPORT: A 54-year-old man presented with palpitations and acute decompensated congestive heart failure. His baseline EKG showed Wolff-Parkinson-White (WPW) pattern. While hospitalized, he had an episode of atrioventricular nodal reentrant tachycardia (AVNRT). He underwent radiofrequency catheter ablation for AVNRT, and his accessory pathway was also ablated even though its conduction was found to be weak. He was clinically doing well on follow-up visit, with resolution of his heart failure symptoms and normalization of left ventricular function on echocardiography.
CONCLUSIONS: This case raises the question whether the accessory pathway plays a role in the development of systolic dysfunction, and if there is any role for ablation in patients with asymptomatic WPW pattern.

Keywords: Electrocardiography, Catheter Ablation - methods, Heart Conduction System - surgery, Humans, Male, Middle Aged, Tachycardia, Atrioventricular Nodal Reentry - surgery, Wolff-Parkinson-White Syndrome - surgery