Pre-excited atrial fibrillation in a woman with minimal pre-excitation: A case report

Abstract

A 46-year-old Thai woman presented with palpitations. A 12-lead electrocardiogram (ECG) showed rapid preexcited atrial fibrillation (AF). The ECG following electrical cardioversion demonstrated minimal pre-excitation with a short PR interval and small apparent delta waves only in leads II, III, V4, and V5. An electrophysiologic study was performed and revealed sinus rhythm with a short H-V interval compatible with pre-excitation. A programmed electrical stimulation revealed orthodromic atrioventricular re-entrant tachycardia via the left lateral accessory pathway. Catheter ablation was successfully performed using a retrograde aortic approach to the left lateral accessory pathway. There was no recurrence of Wolff–Parkinson–White ECG pattern, supraventricular tachycardia, or AF during the 12-month follow-up visit. This is a rare case of minimal preexcitation presenting with pre-excited AF as the first presentation. This case report reflects that minimal preexcitation does not indicate a low risk of ventricular fibrillation and sudden cardiac arrest.