Ebstein's Anomaly of Tricuspid Valve Presenting with Supraventricular Tachycardia: A Case Report

Abstract

Ebstein's anomaly is a rare congenital malformation of the heart. It is characterized by apical displacement of the tricuspid valve leaflets with consequent 'atrialization' of part of the right ventricle. It is commonly associated with conduction system abnormalities and accessory pathways. This is a report of a 25-year-old man presenting with eight months history of recurrent, paroxysmal palpitations which occurred several times a week. On cardiovascular examination, he was normotensive with tachycardia, raised jugular venous pressure, pulsating neck vessels and a loud pulmonary component of second heart sound. Electrocardiogram revealed regular narrow complex tachycardia with right ventricular hypertrophy and right axis deviation. Trans-thoracic echocardiography demonstrated the presence of Ebstein's anomaly of the tricuspid valve. The patient was medically treated with a beta blocker, digoxin and amiodarone. He was subsequently referred to have electrophysiology study for possible radiofrequency ablation and/or surgery which he declined. We present this rare case because it also highlights the difficulties in assessing advanced cardiac interventional therapy such as electrophysiology study in our environment.