Choice of Management in a Rare Case of Symptomatic Wolff-Parkinson-White (WPW) Syndrome Type B

Introduction: Wolff-Parkinson-White (WPW) syndrome type B is a congenital condition involving abnormal electrical conduction between the atria and the ventricles that provide an accessory pathway (AP) for a re-entrant tachycardia circuit. Background: This case report illustrates a 28- year-old male who presented with multiple episodes of rapid, regular palpitations associated with dizziness and nausea. These episodes of palpitations often resolve spontaneously. Physical examination revealed normal first and second heart sounds with no audible murmurs. Other systemic examinations were unremarkable. A 12 lead electrocardiogram showed an atrioventricular re-entrant tachycardia (AVRT) of 210 beats per minute. Intravenous amiodarone was given to which he responded. Post pharmacological cardioversion, the repeated ECG showed shortened PR interval and broad QRS complexes associated with negative delta waves in lead V1, T-wave inversion in inferior leads and precordial leads of V5-V6 which represented a Type B pattern. He was then referred to the electrophysiology unit at the National Heart Institute for radiofrequency ablation (RFA) and Holter monitoring. Conclusion: Wolff-Parkinson-White (WPW) Type B should be considered as a differential diagnosis for a young individual who presents with frequent palpitations. RFA is well known as a permanent solution to the prevention of tachyarrhythmia.