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Challenges in Clinical Electrocardiography
February 4, 2019

Syncope in a Patient With Wolff-Parkinson-White Pattern: Not All That Glitters Is Gold

Author Affiliations
  • 1Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
JAMA Intern Med. 2019;179(3):418-420. doi:10.1001/jamainternmed.2018.7646

A man in his late 60s with a medical history of dyslipidemia presented to the emergency department (ED) with nonprodromal syncope resulting in facial trauma. He was otherwise in good health. In the ED he was asymptomatic with normal vital signs. Physical examination findings were unremarkable except for mild facial trauma sustained during the fall. Laboratory test results were within normal limits. An initial electrocardiogram (ECG) done in the ED demonstrated normal sinus rhythm and ventricular preexcitation mediated by a left accessory pathway (Figure 1A). He was admitted to the cardiology unit under telemetry for consideration of an electrophysiology (EP) study and radiofrequency ablation. While awaiting the procedure, he presented to the nursing station stating that he felt “funny” and had a witnessed syncopal episode, striking his head on the ground. He regained consciousness in a few seconds. Telemetry obtained immediately following the syncopal event while the patient was still on the ground is shown in Figure 1B. Vital signs taken immediately after the fall were stable with a blood pressure of 92/64 mm Hg. After the patient was clinically assessed, telemetry from the moments immediately preceding the syncopal event was obtained (Figure 1C).

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