ATRIAL FIBRILLATION IN PATIENT WITH PREEXCITATION (CASE REPORT)
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i3.15571Keywords:
atrial fibrillation, accessory pathway, preexcitation, Wolff-Parkinson-White syndrome, ablationAbstract
SUMMARY. Ventricular pre-excitation is a cardiac disorder characterized by the presence of an accessory pathway that bypasses the atrioventricular node, which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death due to rapid atrial fibrillation conduction. Early identification of ventricular pre-excitation and proper risk stratification are crucial for determining the most appropriate management strategy and ensuring the safety of these individuals.
The aim – to demonstrate the peculiarities of electrocardiographic diagnosis of atrial fibrillation in a patient with preexcitation, to substantiate the importance of timely diagnosis and treatment.
Material and Methods. Literature publications covering the mechanisms of development and aspects of diagnosis of tachyarrhythmias in patients with preexcitation were analyzed and a clinical case of atrial fibrillation in a patient with Wolff–Parkinson–White syndrome was presented.
Results. A 26-year-old male patient presented to the emergency room with atrial fibrillation and evidence of preexcitation on a 12-lead electrocardiogram. Cardioversion was performed, resulting in a successful restoration of sinus rhythm. The ECG in sinus rhythm revealed persistent preexcitation. The patient was scheduled for an electrophysiological study and radiofrequency ablation.
Conclusions. Atrial fibrillation becomes a potentially fatal arrhythmia in the presence of pre-excitation, as rapid ventricular activation can lead to ventricular fibrillation. Recognizing preexcitation is very important for early treatment. Non-invasive tools such as resting electrocardiograms, ambulatory ECG monitoring, and exercise stress tests are commonly used for this purpose, although their interpretation can sometimes be difficult. Early stratification and management of patients with Wolff-Parkinson-White syndrome is important to reduce the risk of atrial fibrillation and sudden cardiac death. Radiofrequency ablation is an effective treatment for such patients.
References
Wolff-Parkinson-White syndrome: anatomy, epidemiology, clinical manifestations, and diagnosis - UpToDate. Available from: https://www.uptodate.com/contents/wolff-parkinson-white-syndrome-anatomy-epidemiology-clinical-manifestations-and-diagnosis?search=preexcitation%20syndrome&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H158486. [Cited 2023 Jan 21].
Zharinov OY, Kuts VO. Klinichna arytmolohiia [Clinical Arrhythmology]. Kyiv: Chetverta khvylia; 2025. Ukrainian.
Zharinov OY, Kuts VO. Osnovy elektrokardiohrafii [Basics of electrocardiography]. Kyiv: Chetverta khvylia; 2020. Ukrainian.
Skybchyk VA, Skybchyk YaV. Klinichna elektrokardiohrafiia dlia profesionaliv [Clinical electrocardiography for professionals]. Lviv: Bona; 2024. Ukrainian.
Ungaro S, Graziano F, Bondarev S, et al. Electrocardiographic Clues for Early Diagnosis of Ventricular Pre-Excitation and Non-Invasive Risk Stratification in Athletes. A Practical Guide for Sports Cardiologists. J. Cardiovasc. Dev. Dis. 2024;11(10):324. DOI: 10.3390/jcdd11100324. DOI: https://doi.org/10.3390/jcdd11100324
Chhabra L, Goyal A, Benham M. Wolff-Parkinson-White Syndrome. Treasure Island, FL: StatPearls Publishing; 2024.
Bhatia A, Sra J, Akhtar M. Preexcitation Syndromes. Curr. Probl. Cardiol. 2016; 41(3): 99–137. DOI: https://doi.org/10.1016/j.cpcardiol.2015.11.002
Uniat J, Silka M. Risk assessment of pre-excitation: Atrial fibrillation versus atrial flutter. HeartRhythm Case Reports. 2023;9(1):31-33. DOI: https://doi.org/10.1016/j.hrcr.2022.10.003
Joglar J, Chung M, Armbruster A, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):1-156. DOI: 10.1161/CIR.0000000000001193. DOI: https://doi.org/10.1161/CIR.0000000000001207
Sakthivel R, Selvaraj R. Atrial fibrillation and preexatation – A licence to kill. Indian Pacing and Electrophysiology Journal. 2020;20(1):1-2. DOI: https://doi.org/10.1016/j.ipej.2020.01.001
Acharya D, Rane S, Bohora S, Kevadiya H. Incidence, clinical, electrophysiological characteristics and outcomes of patients with Wolff-Parkinson-White Syndrome and atrial fibrillation. IPEJ. 2020;20(1):3-7. DOI: https://doi.org/10.1016/j.ipej.2019.12.015
