Wolff-Parkinson-White syndrome as initial manifestation of Becker muscular dystrophy

Cardiac involvement may precede the onset of muscular manifestations in Becker muscular dystrophy (BMD), but Wolff-Parkinson-White (WPW) syndrome has not been reported as initial cardiac manifestation of BMD.

In a 43-year-old, HIV-negative male, WPW syndrome was diagnosed at age 26 years upon a routine surface ECG, carried out for recurrent palpitations since childhood. Since then, WPW syndrome was occasionally found on repeated cardiologic follow-up investigations. From age 27 years, he developed proximal muscle weakness predominantly of the lower limbs, a positive Gower sign, and a waddling gait. Needle electromyograms were repeatedly myogenic, and upon reinvestigation at age 42 years, a deletion of exons 45-47 in the dystrophin gene was detected. Radiofrequency catheter ablation, initially refused by the patient, was scheduled again but no accessory pathways were detected on electrophysiological investigations.

This case suggests that intermittent WPW syndrome may be a cardiac manifestation of BMD and that cardiac involvement may precede the development of evident skeletal muscle abnormalities.