title: Acute Chest Pain and Broad Complex Tachycardia. A Non-typical Case of Pre-excited Atrial Fibrillation.
abstract: Wolff-Parkinson-White syndrome is a common condition in the emergency department. A case is presented of a 76-year-old patient with acute chest pain and broad complex tachycardia. Despite the fact that previous and post cardioversion ECG tracings in sinus rhythm showed no signs of pre-excitation, the characteristic pattern of pre-excited atrial fibrillation (AF) is recognized and after successful DC cardioversion the patient is referred for catheter ablation of the accessory pathway. This case illustrates a non-typical presentation of the WPW syndrome, with an older patient than usual with slight signs of pre-excitation. We highlight the need for high grades of suspicion for the early recognition of pre-excited AF when attending patients with tachycardia and the obligation to know the distinctive aspects of its management for this potentially life-threatening arrhythmia.
authors.affiliation: Cardiology Unit, Alvarez Buylla Hospital, Mieres (Asturias), Spain.
authors.forename: Ramon Suarez
authors.initials: RS
authors.lastname: Arias
authors.affiliation: Emergency Department, Alvarez Buylla Hospital, Mieres (Asturias), Spain.
authors.forename: Nuria Perez
authors.initials: NP
authors.lastname: Villanueva
authors.affiliation: Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Gustavo Iglesias
authors.initials: GI
authors.lastname: Cubero
authors.affiliation: Cardiology Department - Arrhythmia Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Jose Rubin
authors.initials: JR
authors.lastname: Lopez
keywords: Broad complex tachycardia; Pre-excited atrial fibrillation; Wolff-Parkinson-White syndrome