Just Because You Don't See Something Doesn't Mean It Isn't There: A Case of Intermittent Multiple Accessory Pathways

Intermittent Multiple Accessory Pathways in Wolff- Parkinson-White Syndrome

Abstract

The presence of multiple accessory pathways is an independent risk factor for supraventricular tachycardia due to the potential for rapid conduction of the accessory pathway during atrial fibrillation. Conversely, intermittent preexcitation during sinus rhythm is a presentation of accessory pathways with poor conduction, and the subsequent development of ventricular fibrillation during atrial fibrillation is very rare. In this case, we demonstrate that even multiple accessory pathways can exhibit intermittency on surface ECG.