This is a 16-year-old adolescent, basketball player since he was 5 years old, who came to the Andaluz Center of Sports Medicine (CAMD) of Almería Federation for medical examination requested,
Anamnesis revealed episodes of irregular stools, short and self-limiting, during rest and effort.
At rest ECG, a very short interval between P and R waves (PR interval) with delta wave was detected, compatible with pre-excitation for what was derived for cardiac evaluation.
Among his personal history, a previous evaluation at 9 years, in an asymptomatic patient, with a normal ECG and the reference of a paternal uncle, affected by a recently ablated arrhythmia, stand out.
A new resting ECG confirmed a pre-excited sinus rhythm, compatible with the right anteroseptal pathway, and structural heart disease was ruled out by echocardiography.
In the 24-hour holter, the patient maintained permanent pre-excitation without arrhythmias.
The treadmill stress test with Bruce protocol was conclusive and arrhythmia-free, maintaining WPW at maximum heart rates.
1.
Considering the previous data and his condition as a sportsman, he was sent for electrophysiological study (EFS) and anomalous pathway ablation.
The procedure was performed with two electrocatheters: one for diagnosis with registration of the His and another for mapping and ablation in the septal region pericranial.
Orthodromic tachycardia was induced in sinus rhythm and radiofrequency (RF) was applied on the bidirectional atrioventricular (AV) accessory pathway.
Tachycardia and pre-excitation were interposed and the procedure ended.
He continued with right bundle branch block (RBBB), probably of traumatic origin.
There is no description of effective refractory period of the anomalous pathway.
In the first subsequent follow-up, the patient reported the same symptoms prior to ablation and management for tachycardia discontinuation.
Baseline ECG and 24-hour Holter monitoring showed sinus pattern with WPW, with no documented tachycardia.
Parents have been asked to consult the electrophysiology specialist again to offer the best treatment options in relation to sports practice.
