This is a 16-year-old adolescent, a competitive basketball player since the age of 5, who went to the Andalusian Centre for Sports Medicine (CAMD) in Almeria to undergo a medical examination requested by his Federation. In the anamnesis, he reported episodes of palpitations, short and self-limited, during rest and exertion. The resting ECG showed a very short interval between P and R waves (PR interval) with a delta wave, compatible with pre-excitation, for which he was referred for cardiological assessment.
His personal history included a previous evaluation at the age of 9 years, in an asymptomatic patient, with a normal ECG and the reference of a paternal uncle, affected with a recently ablated arrhythmia.
A new resting ECG confirmed a pre-excited sinus rhythm, compatible with right anteroseptal pathway and structural heart disease was ruled out by echocardiography. The 24-hour rhythm holter showed permanent pre-excitation and no arrhythmias. The treadmill stress test with Bruce protocol was conclusive and free of arrhythmias, maintaining the WPW at maximum heart rates.

Considering the previous data and his condition as a competitive athlete, he was sent for electrophysiological study (EPS) and ablation of the anomalous pathway.
The procedure was performed with two electrocatheters: one for diagnosis with His recording and the other for mapping and ablation in the perihisian septal region. In sinus rhythm, orthodromic tachycardia was induced and radiofrequency (RF) was applied over the bidirectional atrioventricular (AV) accessory pathway. Tachycardia and pre-excitation were interrupted, terminating the procedure. The patient was left with right bundle branch block (RBBB), probably of traumatic origin. There is no description of the effective refractory period of the anomalous pathway.
At the first subsequent follow-up, the patient reported the same clinical manifestations prior to ablation and management to interrupt the tachycardias. The baseline ECG and 24-hour holter maintain the sinus pattern with WPW, with no documented tachycardias.
The parents have been asked to consult the electrophysiology specialist again in order to offer the best treatment options in relation to sports practice.