Unmasking of Wolff-Parkinson-White syndrome following cardioversion of ventricular tachycardia in pregnancy: a case report.

Background: Wolf-Parkinson-White syndrome predisposes patients to tachyarrhythmias and sudden cardiac death, with pregnancy further exacerbating arrhythmia risk due to hemodynamic, hormonal, and autonomic changes. We present a rare case of a pregnant woman with Wolf-Parkinson-White syndrome, which was unmasked after successful cardioversion of unstable ventricular tachycardia.

Case presentation: A 40-year-old Black Ethiopian pregnant woman in her 35th week of gestation presented with unstable ventricular tachycardia, requiring multiple cardioversions, along with treatment with amiodarone and magnesium sulfate. She had a similar episode of unstable ventricular tachycardia 2 years earlier that was managed with cardioversion and subsequent pharmacotherapy, including amiodarone and metoprolol. After stabilization during the current episode, the electrocardiogram showed a short PR interval, delta waves, and wide QRS complexes, indicating previously undiagnosed type A Wolf-Parkinson-White syndrome. Laboratory investigations and echocardiography were unremarkable. The patient received optimal multidisciplinary care except for the absence of an electrophysiology study, which was not available locally. Finally, she delivered a healthy neonate at term via cesarean section with favorable maternal and neonatal outcomes.

Conclusion: This case underscores a rare instance of undiagnosed Wolf-Parkinson-White syndrome presenting as a life-threatening ventricular arrhythmia in pregnancy. It highlights how vigilant post-cardioversion electrocardiogram review can unmask concealed pre-excitation, the necessity of a coordinated multidisciplinary team for prompt stabilization, and the profound impact that limited access to electrophysiology services has on patient care in resource-constrained settings.