Noncompacted ventricular myocardium: is syncope the only warning sign?

We present a case of a 14-year-old young boy with ventricular noncompaction and coexistent Wolff-Parkinson-White syndrome who presented with syncope. Detailed testing was performed, and an ablation was successful for Wolff-Parkinson-White syndrome; however, because of patient/family desires, an implantable cardiodefibrillator was placed. A careful review of the literature highlights the complex decision making involved with this condition.