Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway

Gopinathannair, Rakesh; Campbell, Dwayne N.; Mazur, Alexander

doi:10.1016/s0972-6292(16)30627-1

Cited by 3 publications

(2 citation statements)

References 5 publications

(11 reference statements)

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“…Previous reports mainly focused on the new onset of ventricular pre‐excitation following cardiac surgeries of correcting congenital anatomic abnormalities, such as Ebstein's anomaly, tricuspid atresia, and ventricular septal defect (VSD), which commonly complicated with AP (Ai et al, 1998 ; Chang et al, 2015 ; Hager et al, 2005 ; Peinado et al, 2007 ), while ventricular pre‐excitation following valve replacement is rarely described. Simmers TA and Gopinathannair R respectively reported cases of right AP unveiled following tricuspid valve replacement (Gopinathannair et al, 2013 ; Simmers et al, 2006 ). In our case, the AP was ablated on the mitral valve, which is consistent with the position of the valve procedure.…”

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confidence: 99%

“…, while ventricular pre-excitation following valve replacement is rarely described. Simmers TA and Gopinathannair R respectively reported cases of right AP unveiled following tricuspid valve replacement (Gopinathannair et al, 2013;Simmers et al, 2006). In our case, the AP was ablated on the mitral Hence, we suspected that the exposure of the AP may be associated with valve replacement surgery.…”

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Atrioventricular accessory pathway unmasked by heart valve replacement

Long

2021

Noninvasive Electrocardiol

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A 50-year-old male patient visited the ER for a week of palpitation, chest discomfort, and shortness of breath. He underwent mitral valve and aortic valve replacement surgery for severe valvular regurgitation 3 months ago. Preoperative 12-lead electrocardiogram (ECG)-presented atrial fibrillation (AF) with Q wave in leads V 4 -V 6 (Figure 1a) and 24-h ECG (Holter monitor) revealed alternation of AF and AFL. The patient underwent mitral and aortic valve replacements under cardiopulmonary bypass. The prosthetic valves used in the operation were the Edward biological valve and the Edward mechanical valve, respectively. ECG taken on Day 1 postoperatively showed AFL (3:1-5:1; Figure 1b). The patient received β receptor blocker therapy to control heart rate after the last discharge.Current physical examination: Heart rate was 142 bpm with irregular rhythm; blood pressure was 95/68 mmHg; and the sound of mechanical valve can be detected in the aortic and mitral valve auscultation area. The characteristics of emergency ECG-presented atrial rhythm (Figure 2a) were atypical AFL and bigeminy of premature ventricular contraction (PVC). Considering palpitation and symptomatic PVC, metoprolol and deslanoside were used to control ventricular rate. However, the patient's clinical condition aggravated and the ECG transformed into an irregular wide complex tachycardia (Figure 2b). Some extra characteristics of wide QRS complex included the following: (1) Interval between flutter wave and QRS complex was constant and shorter in wide QRS complex. (2) Divider test shown in Figure 3a indicated atrioventricular association. We considered the diagnosis of ECG was AFL complicated with intermittent ventricular pre-excitation, rather than ventricular tachycardia with exit block. The patient received further electrophysiological (EP) study, and after the AFL ablation, ventricular pre-excitation was observed in sinus rhythm.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Atrioventricular accessory pathway unmasked by heart valve replacement

Long

2021

Noninvasive Electrocardiol

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Analysis of the influencing factors associated with dyssynchrony and cardiac dysfunction in children with ventricular pre-excitation

Zhang

Cui

et al. 2022

Cardiol Young

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Objective: To investigate the correlation between ventricular pre-excitation-related dyssynchrony, on cardiac dysfunction, and recovery. Methods and Results: This study included 76 children (39 boys and 37 girls) with a median age of 5.25 (2.67–10.75) years. The patients with pre-excitation-related cardiac dysfunction (cardiac dysfunction group, n = 34) had a longer standard deviation of the time-to-peak systolic strain of the left ventricle and larger difference between the maximum and minimum times-to-peak systolic strain than those with a normal cardiac function (normal function group, n = 42) (51.77 ± 24.70 ms versus 33.29 ± 9.48 ms, p < 0.05; 185.82 ± 92.51 ms versus 111.93 ± 34.27 ms, p < 0.05, respectively). The cardiac dysfunction group had a maximum time-to-peak systolic strain at the basal segments of the anterior and posterior septa and the normal function group at the basal segments of anterolateral and posterolateral walls. The prevalence of ventricular septal dyssynchrony in the cardiac dysfunction group was significantly higher than that in the normal function group (94.1% (32/34) versus 7.7% (3/42), p < 0.05). The patients with ventricular septal dyssynchrony (n = 35) had a significantly higher prevalence of intra-left ventricular systolic dyssynchrony than those with ventricular septal synchrony (n = 41) (57.1% (20/35) versus 14.6% (6/41), p < 0.05). During follow-up after pathway ablation, the patients who recovered from intra-left ventricular dyssynchrony (n = 29) had a shorter left ventricular ejection fraction recovery time than those who did not (n = 5) (χ2 = 5.94, p < 0.05). Among the patients who recovered, 93.1% (27/29) had a normalised standard deviation of the time-to-peak systolic strain and difference between the maximum and minimum times-to-peak systolic strain within 1 month after ablation. Conclusion: Ventricular pre-excitation may cause ventricular septal dyssynchrony; thus, attention must be paid to intra-left ventricular dyssynchrony and cardiac dysfunction. Whether intra-left ventricular systolic dyssynchrony can resolve within 1 month may be a new early predictor of patient prognosis.

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Effect of Ventricular Preexcitation on Left Ventricular Function in Pediatric Patients with Wolff–Parkinson–White Syndrome

修平¹,

亮²,

圭吾³

et al. 2018

Ped Cardiol Card Surg

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Background: Wolff Parkinson White syndrome with ventricular preexcitation may cause cardiac dysfunction and dilated cardiomyopathy even in the absence of recurrent and incessant tachycardia. Purpose: This study aimed to determine the effect of ventricular preexcitation on cardiac function in pediatric patients with manifest accessory pathway. Methods: We analyzed the clinical data of 20 patients who underwent electrophysiological examination and radiofrequency catheter ablation (RFA) for paroxysmal supraventricular tachycardia associated with accessory pathway [male : female, 8 : 12; age, 12 (0.8 16) years]. We divided the patients into two groups: patients with ventricular preexcitation (manifest group, n 12) and those without ventricular preexcitation (concealed group, n 8). Results: LVEF before RFA was within the normal range in all patients but was significantly lower in the manifest group than in the concealed group [manifest group vs. concealed group, 66.0 (47.7 74.5 ) vs. 78.1 (70.1 83.0 ); p 0.001]. LVEF increased after RFA in the manifest group 66.0 (42.7 74.5 ) vs. 74.4 (52.7 80.7 ); p 0.003]. No change was observed in the LVEF after RFA in the concealed group. Cardiac dysfunction was detected in two patients, with the LVEF of 53.1 and 42.7 , respectively. Both patients were in the manifest group, and the accessory pathway was located at the right posterolateral and right anterolateral, respectively. The LVEF after RFA in these patients improved to 75.7 and 52.7 , respectively. Conclusions: The LVEF was lower in patients with manifest accessory pathway than in patients with concealed accessory pathway, and the LVEF was shown to increase by the disappearance of preexcitation of the manifest accessory pathway.

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Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway

Cited by 3 publications

References 5 publications

Atrioventricular accessory pathway unmasked by heart valve replacement

Atrioventricular accessory pathway unmasked by heart valve replacement

Analysis of the influencing factors associated with dyssynchrony and cardiac dysfunction in children with ventricular pre-excitation

Effect of Ventricular Preexcitation on Left Ventricular Function in Pediatric Patients with Wolff–Parkinson–White Syndrome

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