Atrial fibrillation with WPW syndrome

Atrial fibrillation with WPW syndrome

Atrial fibrillation with WPW syndrome
Atrial fibrillation with WPW syndrome

Atrial fibrillation with WPW syndrome (pre-excitation) is a potentially life threatening arrhythmia. Since it is a wide QRS tachycardia, it is often mistaken for ventricular tachycardia. Due to very fast rates, they often present with hemodynamic compromise requiring cardioversion. In the current strip, a small portion in aVR shows presumably sinus rhythm with pre-excitation. The QRS in general is wide and bizarre. The shortest RR interval gives an estimate of the ventricular refractory period. If it is below 250 msec, it is ominous as the ventricular rates can go very high and it can degenerate into ventricular fibrillation. The arrhythmia also responds to intravenous amiodarone, which can be considered if there is no hemodynamic compromise. Either way radiofrequency catheter ablation has to considered as an elective treatment to prevent recurrence. The ECG after cardioversion (below) shows WPW syndrome (short PR interval and delta waves) with sinus bradycardia.

WPW syndrome with sinus bradycardia
WPW syndrome with sinus bradycardia