A Bundle In The Heart: Wolff-Parkinson-White Syndrome Presenting As Cardiac Arrest
Ventricular fibrillation (VF) is a rare complication of Wolff-Parkinson-White (WPW) Syndrome. We present a case of WPW presenting as VF arrest. A 21-year-old man with no past medical history was brought to emergency department after he experienced an out of hospital VF cardiac arrest after having a cold slushy. Patient achieved return of spontaneous circulation after 30 minutes of advanced cardiac life support. Patient was admitted to Intensive Care Unit for post cardiac arrest care which included targeted temperature management. During his hospitalization, elevated troponin and EKG changes in the inferior leads (II, III and aVF) prompted left heart catheterization. No evidence of coronary artery disease was found. Patient was successfully extubated with good neurological status after rewarming. On review of EKG patient was noted to have shortened PR interval and delta waves in the setting of normal sinus rhythm, thus fulfilling the criteria for WPW syndrome. The morphology of delta waves in the inferior leads was noted to be of pseudo-Q waves. Electrophysiology was consulted and patient underwent successful ablation of the left posterolateral accessory pathway. It was hypothesized that he had an acute vasovagal episode in response to the cold slushy, possibly inducing atrial fibrillation which lead to VF in the setting of WPW syndrome. VF accounts for many sudden cardiac deaths (SCD) in WPW syndrome. SCD is more common in patients symptomatic with WPW. Guidelines and treatment strategies need to be established to screen patients for WPW syndrome.