Wolff-Parkinson-White Syndrome Mimicking ST Elevation Myocardial Infarction: Q waves and ST elevation in a man with palpitations

Abstract

We present a case of a 42-year-old man who had palpitations and his ECG showed Q waves and ST elevation in the inferior leads. His initial ECG also showed pre-excitation. He was diagnosed with Wolff-Parkinson-White (WPW) and underwent posterolateral accessory pathway radio-frequency ablation. The post-ablation ECG showed resolution of the inferior leads Q waves but worsening of the ST elevations. One month later, the ST elevation in the inferior leads resolved. ST elevations in the setting of WPW are thought to be due to repolarization abnormalities and can either persist or resolve after accessory pathway ablation. It is important to differentiate ST elevation secondary to benign repolarization abnormalities in a pre-excited ECG from ST elevation in myocardial infarction which can be masked by pre-excitation or can occur from ablation induced myocardial injury. Our case and discussion review these ECG changes and the differential diagnosis of ST elevations in the setting of ventricular pre-excitation.