Clinical Practice and Cases in Emergency Medicine

Introduction: Wolff-Parkinson-White syndrome is a congenital conduction disorder involving an accessory pathway that predisposes patients to reentrant tachyarrhythmias and, in rare cases, sudden cardiac death. While often asymptomatic, it may predispose patients to serious tachyarrhythmias, particularly under conditions that enhance atrioventricular (AV) conduction. Risk stratification using noninvasive and invasive tools such as electrophysiologic studies is critical to identifying high-risk individuals and guiding treatment decisions such as catheter ablation. Pharmacologic agents that alter autonomic tone may unmask latent pre-excitation. Dicyclomine, an anticholinergic agent used for gastrointestinal disorders, is not an AV-nodal blocking drug but exerts vagolytic effects that can increase sinus rate and AV nodal conduction. Dicyclomine’s vagolytic effects and potential for interaction with other proarrhythmic drugs warrant caution in patients with conduction abnormalities, structural heart disease, or autonomic sensitivity.

Case Report: We report a case of a 36-year-old male who presented to the emergency department with abdominal symptoms and was incidentally found to have Wolff-Parkinson-White pattern following administration of intramuscular dicyclomine.

Conclusion: This case highlights the potential importance of cardiac monitoring, even in patients with non-cardiac chief complaints, particularly when anticholinergic agents are administered.