CONGRESS ABSTRACT

Introduction: Wolff-Parkinson-White (WPW) is a congenital cardiac preexcitation syndrome characterized by abnormal cardiac conduction through an accessory pathway, with the presence of a short PR interval and prolonged QRS complex on the ECG (Delta wave), which can lead to symptomatic arrhythmias. Low-risk patients are characterized by the sudden and complete normalization of the PR interval and the disappearance of the Delta wave during exercise or after procainamide, propafenone, or disopyramide administration. Case Report: Asymptomatic 54-year-old male with intermittent WPW (anteroseptal accessory pathway), affected by arterial hypertension and dyslipidemia. No previous arrhythmic episodes. The stress test is characterized by significant ST-segment depression in the precordial leads with persistent ventricular pre-excitation. The coronary angiography does not show significant stenosis. Discussion: The ST-segment depression during the stress test, typical of ischemia, manifests in half of the patients with Wolff-Parkinson-White (WPW) syndrome. However, the ST-segment depression takes on a different meaning based on the presence or absence of pre-excitation. ST-segment depression during the stress test in the presence of pre-excitation should be considered a false positive, In fact, exercise-induced ST-segment depression in patients with pre-excitation is believed to result from repolarization changes attributed to abnormal myocardial depolarization through the accessory pathway. Conclusion: The stress test cannot be used for the diagnosis of coronary artery disease (CAD) in patients with Wolff-Parkinson-White (WPW) syndrome and manifest pre-excitation, as it often leads to false positive results.