IMR Press / RCM / Volume 25 / Issue 4 / DOI: 10.31083/j.rcm2504125
Open Access Review
Pre-Excited Atrial Fibrillation in Wolff-Parkinson-White (WPW) Syndrome: A Case Report and a Review of the Literature
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1 Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
2 Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
3 Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy
4 Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD 21218, USA
5 Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, NY 10467, USA
6 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44106, USA
*Correspondence: (Marco Schiavone)
Rev. Cardiovasc. Med. 2024, 25(4), 125;
Submitted: 21 October 2023 | Revised: 16 December 2023 | Accepted: 10 January 2024 | Published: 29 March 2024
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Wolff-Parkinson-White (WPW) syndrome is defined by specific electrocardiogram (ECG) changes resulting in ventricular pre-excitation (the so-called WPW pattern), related to the presence of an accessory pathway (AP), combined with recurrent tachyarrhythmias. WPW syndrome is characterized by different supraventricular tachyarrhythmias (SVT), including atrioventricular re-entry tachycardia (AVRT) and atrial fibrillation (AF) with rapid ventricular response, with AVRT being the most common arrhythmia associated with WPW, and AF occurring in up to 50% of patients with WPW. Several mechanisms might be responsible for AF development in the WPW syndrome, and a proper electrocardiographic interpretation is of pivotal importance since misdiagnosing pre-excited AF could lead to the administration of incorrect treatment, potentially inducing ventricular fibrillation (VF). Great awareness of pre-excited AF’s common ECG characteristics as well as associated causes and its treatment is needed to increase diagnostic performance and improve patients’ outcomes. In the present review, starting from a paradigmatic case, we discuss the characteristics of pre-excited AF in the emergency department and its management, focusing on the most common ECG abnormalities, pharmacological and invasive treatment of this rhythm disorder.

pre-excited atrial fibrillation
Wolff-Parkinson-White syndrome
accessory pathway
antiarrhythmic drugs
catheter ablation
Fig. 1.
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