Atypical Presentation of Pre-excited Atrial Fibrillation in an Elderly Patient: A Case Report

Pre-excited atrial fibrillation (AF) is a significant clinical condition associated with Wolff-Parkinson-White (WPW) syndrome, characterized by an accessory pathway that enables rapid conduction of atrial fibrillatory waves to the ventricles, leading to dangerously elevated ventricular rates. While WPW syndrome is typically diagnosed in younger individuals, its occurrence in elderly patients is rare and often underreported. This case report discusses a 79-year-old male with well-controlled hypertension who was admitted for poorly tolerated irregular tachycardia with broad QRS complexes, indicative of pre-excited atrial fibrillation (AF). Urgent synchronized electrical cardioversion successfully restored sinus rhythm. Although catheter ablation was proposed as a definitive treatment, the patient chose to postpone the procedure, with close monitoring implemented afterward. This case underscores the challenges of diagnosing WPW syndrome in elderly patients, the potential dangers of pre-excited AF, and the importance of individualized management strategies tailored to patient preferences and comorbidities.