In time cardio resuscitation saved her life !

   Clinical scenario:

             A 12 years old female while playing with her friends fell down and collapsed in a near by park She was rushed to ER of our hospital .

On examination she was pale , unresponsive .She had no palpable pulse. Her systemic examination was normal .The code blue was announced and she was connected to monitor and CPR was started

She had ventricular fibrillation, the shockable rhythm.She was given 200 joules of biphasic DC shock . With this her pulse appeared .An IV line was started and oxygen 6 Liters/min was started as well .Ambu ventilation with cardiac massage in 30:2 ratio was continued until she gained her rhythm and a systolic BP of 80 mm Hg with high doses of Ionotropes .She was shifted to intensive cardiac care unit and was put on mechanical ventilator .After Being on mechanical ventilation for 3 days she gradually became conscious. ECG Fig 1 was suggestive of WPW syndrome

Wolff-Parkinson-White (WPW) syndrome is defined as a congenital condition involving abnormal conductive cardiac tissue between the atria and the ventricles that provides a pathway for a re entrant tachycardia circuit. Many patients are asymptomatic but some get recurrent episodes of re entrant tachycardias.

The electrical properties of these pathways determined the occurrence of these arrhythmias. Sometimes episodes of atrial fibrillation can get conducted rapidly down these pathways and induce ventricular fibrillation which is a cause of sudden death in these patients.

Fig 1 WPW syndrome , short PR and Delta wave 

Later radio frequency ablation of the aberrant pathway as shown in Fig 2 a was done and patient walked out of the hospital with  a wide smile on her face Click to read about Radio frequency Ablation

Fig 2 Shows RFA of aberrant path way 

  

Teaching message : 

                  

1. In time Cardio pulmonary Resuscitation is life saving 2. Symptom free WPW syndrome never means patient is risk free. These patients should be referred to an electrophysiologist to determine if these aberrant pathways need to be ablated. Patient education is of paramount importance in patients with WPW syndrome. This is especially true in asymptomatic young patients who have been told of their abnormal ECG results. Periodic follow-up care of such patients is necessary, along with thoughtful discussions of consideration for EPS and prophylactic catheter ablation.

Further Reading:  Click to read WPW syndrome

This case was Contributed by :

Dr Mehboob Ali  Dar.

MD, DM, MRCP(UK), FACC,FHRS

Certified EP & Device Specialist, IBHRE,USA European Board ( EHRA) Certified in Invasive Electrophysiology Consultant Interventional Cardiologist 

& Electrophysiologist Prince sultan cardiac center  Qassim, Saudi Arabia