A Rare Case of Wolff-Parkinson-White Syndrome Associated with Right Atrial Aneurysm

Wolff-Parkinson-White syndrome is rarely associated with a right atrial aneurysm. However, when such a condition occurs, it will be hard to manage since pre-excitation will be induced as long as the aneurysm persists.

A 14-year-old female patient received emergency treatment for irregular wide QRS complex tachycardia in our centre, and a pre-excitation pattern was then observed on the surface electrocardiogram. An initial electrophysiological study revealed a high-risk right posterior accessory pathway that was resistant to both radiofrequency and irrigated radiofrequency ablations. Subsequently, fluoroscopy showed that this was due to a right atrial aneurysm. Although successful ablation with irrigated RF was performed in the second procedure, the procedure was considered suboptimal due to the association of aneurysm. Accordingly, we initiated antithrombotic and antiarrhythmic drug therapy. We decided to omit surgery and followed the case under medical treatment for two years without complications.

Here, we report this rare co-existence and our treatment approach in detail.