Working Diagnosis:
Case Photo #1 I Wolff Parkinson White

Treatment:
Radiofrequency Ablation of the Left Lateral Accessory pathway
Case Photo #2 , Case Photo #3

Outcome:
Athlete was able to return to swimming in 2 weeks, with light exercise with gradual increasing intensity and was able to return to full participation in 4 weeks

Author's Comments:
WPW was first described in 1943 as an accessory pathway in healthy young individuals. The classic findings or WPW are shortened PR interval, prolonged QRS, and delta wave. WPW occurs in 1:1000 in athletes with 1% of cardiovascular deaths being attributed to WPW (4).
Presentation with palpitations or sustained tachyarrythmia is common. WPW is due to electrical aberrancies mainly caused by accessory pathways (1). Accessory pathway(s)can predispose athletes to ventricular fibrillation resulting in sudden death (4). Ablation of the accessory pathway is the treatment of choice. Those who cannot tolerate having and Radio Frequency Ablation are treated in with medications.
36th Bethesda Guideline Recommendations:
For those athletes with no structural heart disease who have had successful catheter or surgical ablation, are asymptomatic, and have no inducible arrhythmia on follow up electrophysiologic testing, all competitive sports are permitted in several days. If no electrophysiologic testing is done, full participation is permitted if no spontaneous recurrence of tachycardia for two to four weeks after ablation.

Editor's Comments:
Just a reminder to the members of AMSSM, if you have not already done so, please visit the Free ECG Training Module located under the Education tab on the AMSSM website. It is an online resource and comprehensive training module targeted for physicians around the world to gain expertise and competence in ECG interpretation.

References:
1. Common Type of Supraventricular Tachycardia: Diagnosis and Treatment. Colucci, R et al; Am Fam Physician; 2010 Oct 15; 82(8): 942-952
2. Sudden Cardiac Death
Cambell R.M et al; Brtish J Sports Med 2009; 43(5) 331-41
3. 36th Bethesda Conference
Eligibility Recommendation for Competitive Athletes in Cardiovascular Abnormalities.
J Am College of Cardiology 2005
4. Abnormal Electrocardiographic findings in athletes:
Dreszner, J et al. Br J Sports Medicine 2013; 47(3); 153-167

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