A 25-year-old man was admitted to hospital for electrophysiological studies for Wolf-Parkinson-White syndrome, discovered during a medical clearance examination to be a professional soccer referee. This athlete had no medical history, reported no symptoms and his physical examination was normal. A 12-lead electrocardiogram revealed the presence of ventricular pre-excitation, a negative delta wave in leads I and aV L , and right bundle branch-type QRS morphology, consistent with a left lateral accessory pathway ( Fig. 1 ), which persisted during peak exercise.
Electrophysiological studies confirmed the presence of a left lateral accessory pathway and the induction of atrial fibrillation by rapid atrial pacing, immediately followed by the development of ventricular fibrillation ( Fig. 2a, b ), requiring the delivery of two consecutive biphasic 200J DC shocks to restore sinus rhythm ( Fig. 3a ). The patient underwent transseptal radiofrequency ablation of the left lateral accessory pathway ( Fig. 3 b).
