Case of WPW and anomalous right coronary in a teenager with cardiac symptoms

A 17-year-old African-American man was being followed for palpitations and chest pain. CT angiography revealed an anomalous right coronary artery from the left coronary sinus and he underwent unroofing of the right coronary ostium. There was a manifest pre-excitation on postoperative ECGs, and review of prior ECGs at initial presentation showed subtle pre-excitation suggesting a left lateral pathway. An electrophysiology study revealed easily inducible supraventricular tachycardia (SVT) and rapid anterograde conduction via the pathway which was successfully ablated. Eight months postablation, the patient remains asymptomatic with no evidence of pre-excitation on ECG.