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

Introduction

A 46-year-old Thai woman presented with palpitation. A 12-lead electrocardiogram (ECG) showed rapid rate of preexcited atrial fibrillation (AF). The subsequent ECG after electrical cardioversion demonstrated minimal preexcitation with short PR interval, and apparently small delta waves only in leads II, III, V4, and V5. An electrophysiologic study was performed and showed sinus rhythm with short H-V interval compatible with preexcitation. A programmed electrical stimulation showed orthodromic atrioventricular reentrant tachycardia utilizing left lateral accessory pathway. The catheter ablation was successfully performed via retrograde aortic approach to left lateral accessory pathway. There was no recurrence of Wolff-Parkinson-White (WPW) ECG pattern, supraventricular tachycardia, or AF during 3-month follow-up visit.