Amiodarone Induced Ventricular Fibrillation in Unveiled WPW Syndrome: A Resource-Limited Setting Dilemma

Wolff-Parkinson-White (WPW) syndrome predisposes patients to life-threatening tachyarrhythmias due to rapid ventricular activation via an accessory pathway. Malignant arrhythmias may occur unexpectedly, even in previously asymptomatic individuals.

A 36-year-old man presented with sudden palpitations and a regular wide-complex tachycardia consistent with antidromic atrioventricular reentrant tachycardia. The rhythm rapidly deteriorated into preexcited atrial fibrillation and progressed to ventricular fibrillation cardiac arrest requiring immediate defibrillation and cardiopulmonary resuscitation, with successful return of spontaneous circulation. Postresuscitation electrocardiography demonstrated persistent ventricular preexcitation. Electrophysiological study subsequently confirmed a left lateral accessory pathway, and successful radiofrequency catheter ablation resulted in complete resolution of ventricular preexcitation.

This case highlights the malignant electrophysiological behavior of WPW and the diagnostic and therapeutic challenges of wide-complex tachycardia, particularly in resource-limited settings.

WPW may rapidly progress from antidromic atrioventricular reentrant tachycardia to ventricular fibrillation. Early recognition, prompt electrical cardioversion/defibrillation, and timely referral for catheter ablation are critical.