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.

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Xian, C. , Shajahan, R. , Hwa, P. , Pillai, N. and Kasinathan, G. (2015) Choice of Management in a Rare Case of Symptomatic Wolff-Parkinson-White (WPW) Syndrome Type B. Open Access Library Journal, 2, 1-6. doi: 10.4236/oalib.1102219.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kulig, J. and Koplan, B.A. (2010) Wolff-Parkinson-White Syndrome and Accessory Pathways. Circulation, 122, 480-483.
[2] Keating, L., Morris, F.P. and Brady, W.J. (2003) Electrocardiographic Features of Wolff-Parkinson-White Syndrome. Emergency Medicine Journal, 20, 491-493.
[3] Mark, D., Brady, W. and Pines, J. (2009) Preexcitation Syndromes: Diagnostic Consideration in the ED. The American Journal of Emergency Medicine, 27, 878-888.
[4] Lu, C., Wu, M., Chen, H., Kao, F. and Huang, S. (2014) Epidemiological Profile of Wolff-Parkinson-White Syndrome in a General Population Younger than 50 Years of Age in an Era of Radiofrequency Catheter Ablation. International Journal of Cardiology, 174, 530-534.
[5] De Bacquer, D. (2000) Prevalences of ECG Findings in Large Population Based Samples of Men and Women. Heart, 84, 625-633.
[6] Deboer, S. (1926) Die physiologiche Grundlage und Klinik des unregelmassigen Herzschlages. Ergebnisse der Inneren Medizin und Kinderheilkunde, 29, 391-514.
[7] Durrer, D. and Roos, J. (1967) Epicardial Excitation of the Ventricles in a Patient with Wolff-Parkinson-White Syndrome (Type B). Circulation, 35, 15-21.
[8] Milsten, S., Sharma, A.D., Guiraudon, G.M., et al. (1987) An Algorithm for the Electrocardiographic Localization of Accessory Pathways in the Wolff-Parkinson-White Syndrome. Cardiac Investigational Unit of University Hospital, London, Ontario, Canada, Vol. 10, 555-565.
[9] Chiang, C.E., Chen, S.A., Teo, W.S., et al. (1995) An Accurate Stepwise Electrocardiographic Algorithm for localization of Accessory Pathways in Patients With Wolff-Parkinson-White Syndrome from a Comprehensive Analysis of Delta Waves and R/S Ratio During Sinus Rhythm. The American Journal of Cardiology, 76, 40-46.
[10] Taguchi, N., Yoshida, N., Inden, Y., Yamamoto, T., Miyata, S., Fujita, M., et al. (2014) A Simple Algorithm for Localizing Accessory Pathways in Patients with Wolff-Parkinson-White Syndrome Using Only the R/S Ratio. Journal of Arrhythmia, 30, 439-443.
[11] Svendsen, J., Dagres, N., Dobreanu, D., Bongiorni, M., Marinskis, G. and Blomstrom-Lundqvist, C. (2013) Current Strategy for Treatment of Patients with Wolff-Parkinson-White Syndrome and Asymptomatic Preexcitation in Europe: European Heart Rhythm Association survey. Europace, 5, 750-753.
[12] American College of Cardiology/American Heart Association (2006) Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation and Cardioversion: A Report of the American College of Cardiology/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training: Developed in Collaboration With the Heart Rhythm Society. Circulation, 114, 1654-1668.
[13] Calkins, H., Yong, P., Miller, J., Olshansky, B., Carlson, M., Saul, J., et al. (1999) Catheter Ablation of Accessory Pathways, Atrioventricular Nodal Reentrant Tachycardia, and the Atrioventricular Junction: Final Results of a Prospective, Multicenter Clinical Trial. Circulation, 99, 262-270.
[14] Pappone, C., Vicedomini, G., Manguso, F., Saviano, M., Baldi, M., Pappone, A., et al. (2014) Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation: Insights from a Registry Study of 2169 Patients. Circulation, 130, 811-819.

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