Multiple Atrioventricular Accesory Pathways in a Young Patient with Syncope, Atrial Fibrillation and Fasciculoventricular Fiber

pp 551-557

Abstract

Multiple accessory pathways in patients with the Wolff-Parkinson-White syndrome are infrequent, and they are associated with a higher risk of ventricular fibrillation. We present an exceptional case of a patient with four accessory pathways with anterograde conduction and a fasciculo ventricular fiber in whom we perform a radiofrequency ablation. A 20-year-old man presented with syncope and was admitted to the emergency department. An eletrocardiogram showed a persistent delta wave with a short PR interval. Atrial stimulation demonstrated a decremental conduction with a progressive lengthening of the AH interval and no modification in the HV interval nor of the preexcitation pattern, demonstrative of the presence of a fasciculoventricular fibers. The present exceptional case report is demonstrative of the complexity of the Wolff-Parkinson-White syndrome, and the feasibility and efficacy of radiofrequency catheter ablation in a single procedure.