Wolff-Parkinson-White Syndrome Type ‘A’ Diagnosed as VT

Report:

Atrial fibrillation with rapid response 177/min

Anomalous conduction except for last three beats

WPW syndrome

Comment:

This is a fairly typical example, showing either completely anomalous or completely normal complexes. The Cardiology Registrar and Casualty staff noted the presence of atrial fibrillation (“monomorphic VT – in and out of AF”) but did not connect the two. Although monomorphic VT can be quite irregular, it cannot be so to this extent.

The ventricular rate is not very fast and in fact slowed down well with amiodarone (Fig 90a). It was still deemed unacceptable and he was cardioverted electrically to sinus rhythm with typical delta waves (Fig 90b), when the diagnosis became obvious – even to the aforesaid Casualty staff. He was discharged home from CCU on sotalol and referred for EPS and ablation because of his young age and the appearance of atrial fibrillation.

90a. A relatively rare sight of AF with ‘controlled ventricular response’ in WPW syndrome. 90b. Sinus rhythm showing WPW ‘A’ pattern in V1. It is positively concordant albeit the delta waves are isoelectric in V5-6, making the complexes look normal there. 91. 82 year old lady investigated for GI bleeding. She spent several days in CCU, where AF associated with angina and LBBB was controlled by sotalol 80 mg BD. The ECG below was taken back on Gastroenterology ward and was not reported before her discharge home.