Preexcitation syndrome unveiling Ebstein’s anomaly at an exceptionally advanced age: A case report

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Abstract Background: Ebstein’s anomaly represents an infrequent congenital cardiac anomaly characterized by atypical tricuspid valve morphology, accompanied by the displacement of the septal and posterior leaflets towards the right ventricle. This condition is commonly associated with a variety of arrhythmias, including atrial fibrillation. Pre-excited atrial fibrillation denotes a distinct subtype of atrial fibrillation in which an accessory pathway bypasses the standard atrioventricular conduction system, consequently leading to rapid ventricular response rates. Case presentation: We present a unique instance of atrial fibrillation with preexcitation revealing Ebstein’s anomaly in an elderly patient. The patient, a 71-year-old individual with no previous medical or surgical history, presented with symptoms of palpitations and shortness of breath. The clinical examination revealed a rapid tachycardia that was poorly tolerated hemodynamically. Electrocardiogram findings demonstrated characteristic features of preexcited atrial fibrillation, which were subsequently confirmed by an electrophysiological study, indicating the presence of an accessory pathway. Echocardiography revealed the typical manifestations of Ebstein’s anomaly. Initially, the patient underwent urgent cardioversion, which successfully restored sinus rhythm. Since the ablation procedure was unsuccessful, the patient's treatment approach was modified to focus on medical management, which ultimately resulted in a favorable outcome. Conclusions: This unique case sheds light on the complex interplay between cardiac arrhythmias and adult congenital heart disease. Early diagnosis and comprehensive management are crucial in optimizing outcomes and improving the quality of life for patients with this rare combination of cardiac abnormalities. Further research is warranted to better understand the optimal treatment strategies, and long-term outcomes in this specific population.

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