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Peer-reviewedCC BY-NC-ND 4.0The American Journal of Case Reports

Unveiling Asymptomatic Atrioventricular Reciprocating Tachycardia in a Patient With Wolff-Parkinson-White Syndrome and Multiple Sclerosis

  • Deitrich Gerlt1
  • Ravi Patel1
  • Michael Mogg1
  • Julia Bruggemann2
  • Oladipupo Olafiranye3
  • Somya Chandrasekaran3
  1. 1Department of Internal Medicine, Methodist Dallas Medical Center, Dallas, TX, USA
  2. 2Texas College of Osteopathic Medicine, Fort Worth, TX, USA
  3. 3Department of Medicine, Division of Cardiology, UT Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, USA
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Abstract

Patient: Female, 54-year-old

Final Diagnosis: Wolff-Parkinson-White syndrome (WPW)

Symptoms: Palpitation

Clinical Procedure: Ablation

Specialty: Cardiology • Neurology

Objective: Rare coexistence of disease or pathology

Background: Intermittent accessory pathway conduction can obscure the electrocardiographic diagnosis of Wolff-Parkinson-White (WPW) syndrome on resting electrocardiograms (ECGs). Furthermore, sensory disruptions characteristic of multiple sclerosis (MS) can blunt symptom perception, masking potentially life-threatening hemodynamic instability.

Case Report: A 54-year-old woman with secondary-progressive MS (SPMS) was admitted for a complicated urinary tract infection. The admitting ECG demonstrated sinus tachycardia without preexcitation. Telemetry subsequently revealed narrow-complex tachycardia at 220 beats per minute (BPM) with concurrent hypotension. Despite hemodynamic instability, the patient explicitly denied palpitations, chest pain, or presyncope. She had discontinued fingolimod several years earlier because of palpitations, a detail retrospectively suggestive of an accessory pathway. Review of records identified historical ECGs with intermittent delta waves and short PR intervals, confirming the presence of an accessory pathway with intermittent antegrade conduction. A 12-lead ECG during the acute event confirmed orthodromic atrioventricular reciprocating tachycardia (AVRT). The patient underwent successful synchronized cardioversion followed by radiofrequency ablation of a left-sided anterolateral accessory pathway via electrophysiological study (EPS).

Conclusions: This case illustrates the “ECG dilemma” of intermittent preexcitation, in which the absence of delta waves on a resting tracing does not exclude accessory pathway-mediated tachycardia. It further highlights that patients with neuro-modulating diseases, such as MS, may lack classical “alarm” symptoms for arrhythmia due to progressive autonomic and sensory dysfunction. Clinicians must maintain a high index of suspicion for concealed arrhythmias in this population, as neurological impairment can dissociate hemodynamic instability from subjective symptom perception. Objective monitoring with telemetry is essential to prevent adverse outcomes in this vulnerable population.

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Cite

BibTeXRIS
BibTeX
@article{gerlt2026unveiling,
  title = {{Unveiling Asymptomatic Atrioventricular Reciprocating Tachycardia in a Patient With Wolff-Parkinson-White Syndrome and Multiple Sclerosis}},
  author = {Deitrich Gerlt and Ravi Patel and Michael Mogg and Julia Bruggemann and Oladipupo Olafiranye and Somya Chandrasekaran},
  journal = {The American Journal of Case Reports},
  year = {2026},
  month = oct,
  doi = {10.12659/ajcr.953508},
  url = {https://doi.org/10.12659/ajcr.953508},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Unveiling Asymptomatic Atrioventricular Reciprocating Tachycardia in a Patient With Wolff-Parkinson-White Syndrome and Multiple Sclerosis
AU  - Deitrich Gerlt
AU  - Ravi Patel
AU  - Michael Mogg
AU  - Julia Bruggemann
AU  - Oladipupo Olafiranye
AU  - Somya Chandrasekaran
PY  - 2026
DA  - 2026/10/31
JO  - The American Journal of Case Reports
DO  - 10.12659/ajcr.953508
UR  - https://doi.org/10.12659/ajcr.953508
AB  - Patient: Female, 54-year-old  Final Diagnosis: Wolff-Parkinson-White syndrome (WPW)  Symptoms: Palpitation  Clinical Procedure: Ablation  Specialty: Cardiology • Neurology  Objective: Rare coexistence of disease or pathology  Background: Intermittent accessory pathway conduction can obscure the electrocardiographic diagnosis of Wolff-Parkinson-White (WPW) syndrome on resting electrocardiograms (ECGs). Furthermore, sensory disruptions characteristic of multiple sclerosis (MS) can blunt symptom perception, masking potentially life-threatening hemodynamic instability.  Case Report: A 54-year-old woman with secondary-progressive MS (SPMS) was admitted for a complicated urinary tract infection. The admitting ECG demonstrated sinus tachycardia without preexcitation. Telemetry subsequently revealed narrow-complex tachycardia at 220 beats per minute (BPM) with concurrent hypotension. Despite hemodynamic instability, the patient explicitly denied palpitations, chest pain, or presyncope. She had discontinued fingolimod several years earlier because of palpitations, a detail retrospectively suggestive of an accessory pathway. Review of records identified historical ECGs with intermittent delta waves and short PR intervals, confirming the presence of an accessory pathway with intermittent antegrade conduction. A 12-lead ECG during the acute event confirmed orthodromic atrioventricular reciprocating tachycardia (AVRT). The patient underwent successful synchronized cardioversion followed by radiofrequency ablation of a left-sided anterolateral accessory pathway via electrophysiological study (EPS).  Conclusions: This case illustrates the “ECG dilemma” of intermittent preexcitation, in which the absence of delta waves on a resting tracing does not exclude accessory pathway-mediated tachycardia. It further highlights that patients with neuro-modulating diseases, such as MS, may lack classical “alarm” symptoms for arrhythmia due to progressive autonomic and sensory dysfunction. Clinicians must maintain a high index of suspicion for concealed arrhythmias in this population, as neurological impairment can dissociate hemodynamic instability from subjective symptom perception. Objective monitoring with telemetry is essential to prevent adverse outcomes in this vulnerable population.
SN  - 1941-5923
ER  -