Preexcited Atrial Fibrillation in an 83-Year-Old Patient with Wolff-Parkinson-White Syndrome: Successful Accessory Pathway Ablation. an Unusual Case Report Due to Age and Literature Review

Abstract

We present the case of an 83-year-old woman with well-controlled systemic arterial hypertension who was admitted due to the sudden onset of palpitations, dyspnea, nausea, and dizziness. The initial electrocardiogram revealed a wide QRS, irregular tachycardia with high ventricular rate and hemodynamic compromise, later identified as preexcited atrial fibrillation conducted with aberrancy. Due to lack of response to intravenous amiodarone and progression to 220 bpm with signs of low cardiac output, synchronized electrical cardioversion was performed successfully. The post-cardioversion ECG showed features consistent with Wolff-Parkinson-White (WPW) syndrome, including a short PR interval and delta wave, which were later confirmed by an electrophysiological study.

Echocardiography revealed preserved left ventricular function and no significant structural heart disease, while coronary angiography ruled out obstructive coronary artery disease. The patient was referred to a tertiary care center where successful ablation of a right posteroseptal accessory pathway was performed. At six-month follow-up, she remains asymptomatic and free of arrhythmia recurrence.

This case highlights the importance of recognizing preexcited atrial fibrillation as a potentially life-threatening manifestation of WPW syndrome, even in elderly patients, where presentation is uncommon but possible. It also demonstrates that catheter ablation is a safe and effective curative option in well-selected geriatric patients, challenging the traditional reluctance to perform invasive procedures solely based on chronological age.