Sudden death in a young competitive athlete with Wolff-Parkinson-White syndrome

The case history is documented of a young competitive athlete known to have the electrocardiographic pattern of the Wolff-Parkinson-White syndrome, but considered asymptomatic. On that basis competitive sport was not proscribed. In retrospect, he had experienced occasional tachycardias which were of short duration and ended spontaneously. He never requested medical advice. The boy was first admitted for an attack of rapid heart beating which did not readily subside. He was medicated with prajmalium and left the hospital in stable condition. He died suddenly 10 days after discharge. Autopsy examination of the heart revealed an accessory atrioventricular connection in the posterior septal region. The case history underlines that in some patients with the Wolff-Parkinson-White syndrome the clinical manifestation can be minimal and may be easily ignored by the patient. In retrospect, benign episodes of rapid heart beating most likely were due to a circus movement tachycardia, related to an accessory atrioventricular connection. The sudden death can be attributed to atrial fibrillation with rapid ventricular response via the anomalous connection, despite medical treatment. The observation endorses the potential danger of the Wolff-Parkinson-White syndrome in patients with minimal clinical manifestations. A meticulous histologic study of the atrioventricular junction in hearts of young athletes with sudden and unexplained death is a necessity.