Acceleration of the ventricular response to atrial flutter by amiodarone in an infant with Wolff-Parkinson-White syndrome

The manifestation of atrial flutter, particularly with 1:1 conduction, is rare in patients with ventricular preexcitation secondary to Wolff-Parkinson-White Syndrome (WPW). Very few cases have been reported in the literature. We present a 40-year old male with a history of untreated WPW who presented with severe chest pain and shortness of breath. He was found to have a rapid, regular, wide complex tachycardia. He underwent successful synchronized cardioversion, in which the patient converted tonormal sinus rhythm with classic WPW waveform characteristics, including a shortened PR interval and prolonged QRS complex with a slurred upstroke. Surprisingly, a subsequent electrophysiology study revealed atrial flutter, with bystander conduction of 1:1 atrial flutter being the most likely cause of the patient’s presenting symptoms, and a posteroseptal accessory pathway consistent with the diagnosis of WPW. While considerably rarer than ventricular tachycardia or AVRT, it is nevertheless important for clinicians to consider atrial flutter with 1:1 conduction as a potential diagnosis in patients with WPW presenting with wide complex tachycardia.

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Spontaneous conversion of atrial flutter to antidromic atrioventricular reciprocating tachycardia in the Wolff-Parkinson-White syndrome

American Heart Journal ◽

10.1016/0002-8703(88)90903-9 ◽

1988 ◽

Vol 115 (4) ◽

pp. 917-919 ◽

Cited By ~ 2

Author(s):

Edward C Huycke ◽

Ngai X Nguyen ◽

Wen Ter Lai ◽

Ruey J Sung

Keyword(s):

Atrial Flutter ◽

White Syndrome ◽

Atrioventricular Reciprocating Tachycardia ◽

Wolff Parkinson White Syndrome ◽

Spontaneous Conversion

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Mechanisms of spontaneous alternation between reciprocating tachycardia and atrial flutter-fibrillation in the Wolff-Parkinson-White syndrome.

Circulation ◽

10.1161/01.cir.56.3.409 ◽

1977 ◽

Vol 56 (3) ◽

pp. 409-416 ◽

Cited By ~ 100

Author(s):

R J Sung ◽

A Castellanos ◽

S M Mallon ◽

M G Bloom ◽

H Gelband ◽

...

Keyword(s):

Atrial Flutter ◽

Spontaneous Alternation ◽

White Syndrome ◽

Wolff Parkinson White Syndrome

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Preexcitation Syndrome Presented with Ventricular Tachycardia - A Case Report

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v5i2.4585 ◽

1970 ◽

Vol 5 (2) ◽

pp. 46-48

Author(s):

MR Alam ◽

SMB Hussain ◽

MN Ahsan ◽

SB Siraj

Keyword(s):

Ventricular Tachycardia ◽

Health Care Providers ◽

Past History ◽

Care Providers ◽

White Syndrome ◽

Ventricular Response ◽

Peripheral Pulse ◽

Dc Cardioversion ◽

Electrocardiogram Ecg ◽

Wolff Parkinson White Syndrome

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

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