Ebstein's anomaly as a cause of paroxysmal atrial fibrillation

Abstract

Background. Ebstein's anomaly is characterized by a displacement of the tricuspid valve toward apex, because of anomalous attachment of the tricuspid leaflets. There are type B of Wolff-Parkinson-White (WPW) syndrome and paroxysmal arrhythmias in more than a half of all patients. Case report. We presented a female, 32-year old, with frequent paroxysms of atrial fibrillation. After conversion of rhythm an ECG showed WPW syndrome. Echocardiographic examination discovered normal size of the left cardiac chambers with paradoxical ventricular septal motion. The right ventricle was very small because of its atrialization. The origin of the tricuspid valve was 20 mm closer to apex of the right ventricle than the origin of the mitral valve. Electrophysiological examination showed a posterolateral right accesorial pathway. Atrial fibrillation was induced very easily in electrophysiological laboratory and a successful ablation of accessorial pathway was made. There were no WPW syndrome and paroxysms of atrial fibrillation after that. Conclusion. Ebstein's anomaly is one of the reasons of paroxysmal atrial fibrillation, especially in young persons with WPW syndrome.Uvod. Epstajnova anomalija karakterise se pomeranjem trikuspidne valvule ka apeksu zbog anomalnog pripoja trikuspidnih kuspisa. Kod vise od polovine bolesnika postoje Wolff-Parkinson-White (WPW) sindrom i paroksizmalna aritmija. Prikaz bolesnika. Prikazana je zena, stara 32 godine, koja je imala ceste paroksizme atrijalne fibrilacije. Posle konverzije ritma EKG je pokazivao WPW sindrom. Ehokardiografskim pregledom nadjena je normalna velicina levih srcanih supljina sa paradoksnim pokretima komorskog septuma. Desna komora bila je vrlo mala zbog njene atrijalizacije. Pocetak trikuspidne valvule bio je 20 mm blizi apeksu desne komore nego pocetak mitralne valvule. Elektrofizioloskim ispitivanjem dokazano je prisustvo desnog posterolateralnog akcesornog puta. Atrijalna fibrilacija lako je izazvana u elektrofizioloskoj laboratoriji, a zatim je ucinjena uspesna ablacija akcesornog puta. Posle toga nije bilo WPW sindroma ni paroksizama atrijalne fibrilacije. Zakljucak. Epstajnova anomalija jedan je od razloga paroksizmalne atrijalne fibrilacije, narocito kod mladih osoba sa WPW sindromom.