CATHETER ABLATION AS AN EMERGENCY INTERVE NTION IN WOLFF-PARKINSON-WHITE SYNDROME WITH ACUTE MYOCARDIAL-INFARCTION

A 53-year-old man known to have Wolff-Parkinson-White syndrome suffere d an acute posterior-wall myocardial infarction. Despite successful th rombolysis treatment with streptokinase he continued to have attacks o f supraventricular tachycardia with angina. The ECG showed a short P-R interval and pre-excitation with positive delta waves in leads V-1-6, as well as signs of re-infarction. The tachycardias could not be sati sfactorily suppressed by drug treatment. Coronary angiography revealed triple vessel disease. During this investigation ventricular extrasys toles occurred which initiated orthodromic supraventricular tachycardi a and angina, as well as monophasic S-T elevations in leads II, III an d aVF. This provided the indication for immediate high-frequency cathe ter ablation left laterally at the mitral anulus after a left-lateral accessory conduction pathway had been identified. Three days later the stenoses of the circumflex and anterior interventricular branches wer e dilated. The patient has been free of symptoms for 3 months and can exercise up to 150 W. The tachycardias have not recurred.