Wolff-Parkinson-White pattern in the setting of antibody-mediated rejection after heart transplant.

Donor heart availability is a major issue that affects heart transplantation worldwide. Inclusion of hearts with minor or treatable conditions expands the pool of available organs. Hearts with known Wolff-Parkinson-White (WPW) syndrome are typically excluded from transplantation. Case reports where WPW syndrome is discovered post-transplant have been reported, and many donor heart recipients ultimately undergo post-operative electrophysiology study (EPS) and ablation. We present a case of manifest pre-excitation developing in the setting of antibody-mediated rejection in a patient whose donor heart had no known history of WPW.