Septal Dyskinesia and Global Left Ventricular Dysfunction in Pediatric Wolff‐Parkinson‐White Syndrome with Septal Accessory Pathway

Kwon, Bo Sang; Bae, Eun Jung; Kim, Jun Seok; Noh, Chung Il; Choi, Jung Yun; Yun, Yong Soo

doi:10.1111/j.1540-8167.2009.01612.x

Cited by 69 publications

(93 citation statements)

References 22 publications

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“…A previous report showed that LV dyssynchrony induces low cardiac output which leads to cardiac failure in some cases. 15) However, in our case, the cause of the high levels of BNP might be LV hypertrophy and the high value of LV pressure overload. Carvedilol and cibenzoline were effective for reduction of BNP levels due to relief of the LVOT pressure gradient.…”

Section: Discussionmentioning

confidence: 88%

Radiofrequency Catheter Ablation of the Accessory Pathway Adversely Affected the Left Ventricular Outflow Tract Pressure Gradient in a Patient With Hypertrophic Obstructive Cardiomyopathy

et al. 2013

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SummaryAlthough hypertrophic cardiomyopathy (HCM) with an accessory pathway is encountered in clinical practice, there is little evidence of a coherent strategy for ablation of the accessory pathway in patients with HCM. We present the case of a 61-year-old man who had type B Wolff-Parkinson-White (WPW) syndrome with hypertrophic obstructive cardiomyopathy (HOCM). Due to paroxysmal atrial fibrillation, he underwent radiofrequency catheter ablation of the accessory pathway located in the right postero-lateral wall to prevent secondary symptomatic events. His LV dyssynchrony improved after the procedure, but the degree of the LV outflow tract (LVOT) pressure gradient was increased. To stabilize the LVOT pressure gradient, he needed additional medications. This case shows that patients with HOCM should be carefully evaluated before making a decision concerning ablation of the accessory pathway. ( 1,2) Radiofrequency catheter ablation (RFA) of the accessory pathway is acceptable first-time therapy for symptomatic WPW syndrome. On the other hand, hypertrophic obstructive cardiomyopathy (HOCM), which is characterized by LV outflow obstruction due to hypertrophy, predisposes the patients to hemodynamic collapse and thereby to a severe LV outflow tract (LVOT) pressure gradient.3) Although a previous report showed that 5% of patients with hypertrophic cardiomyopathy (HCM) had ventricular pre-excitation, the comorbidity of WPW syndrome and HOCM is rarely encountered in clinical practice.4) Patients with HOCM, generally, should be controlled with relative bradycardia, because the LV diastolic volume will be relatively increased and, accordingly, the LVOT pressure gradient will be relieved. In this regard, if they have an accessory pathway and experience AF, RFA is recommended for suppression of tachyarrhythmia. However, while deletion of the accessory pathway improves LV dyssynchrony, it may adversely affect the LVOT pressure gradient. There are some reports showing that the pressure gradient of HOCM is ameliorated by dual chamber pacing with short atrioventricular delay, which leads to LV dyssynchronous contraction. 5,6) In this regard, LV dyssynchrony might be required to relieve the LVOT pressure gradient of HOCM. We present a patient with both WPW syndrome and HOCM in whom the LVOT pressure gradient was affected by RFA. Case ReportA 61-year-old man with no remarkable past medical history was brought to our hospital because of a pre-syncopal episode. He had felt chest discomfort and faintness about 30 minutes after lunch. His vital signs were stable and the symptoms had disappeared at the time of consultation. On physical examination, a systolic murmur was maximally audible from the middle left sternal border. There was no pitting edema in the lower extremities, and no abnormality in the neurological findings. Although most of his laboratory data were normal, his blood level of B-type natriuretic peptide (BNP) was high (325 pg/mL). A 12-lead electrocardiogram (ECG) showed a profound high-voltage of R wave (S wave in V1 ...

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Section: Discussionmentioning

confidence: 88%

Radiofrequency Catheter Ablation of the Accessory Pathway Adversely Affected the Left Ventricular Outflow Tract Pressure Gradient in a Patient With Hypertrophic Obstructive Cardiomyopathy

et al. 2013

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“…Interestingly, the abnormal septal motion associated with this contractile pattern is more frequently found in patients with a prolonged QRS duration in both WPW 8,12 and LBBB patients. 11 In patients with an LBBB and heart failure receiving CRT, this classical LBBB longitudinal strain pattern has been linked to the occurrence of LV reverse remodeling, improvement in LV function, and clinical outcome, even in patients with relatively narrow QRS (120-150 ms) in whom the benefit of CRT remains uncertain.…”

Section: Wpw Syndrome Septal Preexcitation Dyssynchrony and Cardiamentioning

confidence: 99%

“…7 Reduced IVS motion and LV dyssynchrony associated with septal AP may result in LV dysfunction, which resolves after radiofrequency ablation, even in the absence of permanent tachycardia. 8,9 In both septal AP ( Figure A) and LBBB ( Figure D), activation proceeds across the septum at the breakthrough point before reaching the LV endocardium. It then slowly propagates to the endocardium of the posterolateral wall, with a basal breakthrough site in the event of an AP and more often a mid to apical septal one in the event of an LBBB.…”

Section: Wpw Syndrome Septal Preexcitation Dyssynchrony and Cardiamentioning

confidence: 99%

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The Wolff–Parkinson–White Syndrome

Maréchaux

2016

Circ: Cardiovascular Imaging

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A mong patients with a Wolff-Parkinson-White (WPW) syndrome, approximately half will experience arrhythmia during their lifetime. Radiofrequency catheter ablation of the accessory atrioventricular pathway is the treatment of choice for this condition and is associated with a high success rate. Electrophysiology study is indeed the key procedure for identifying the target of radiofrequency ablation. The present prospective study, published in this issue of Circulation: Cardiovascular Imaging by Ishizu et al, investigated the ability of a new imaging technology based on 3-dimensional speckle-tracking (ST) strain echocardiography in localizing AP in WPW syndrome.1 This tool, named isochrone activation imaging (AI), was accurate enough to assess synchronized activation in the normal heart and to detect contractile abnormalities, which approximately matched ablation site in WPW patients with left-or right-sided AP. See Article by Ishizu et al Localization of Accessory Pathways With Echocardiography, a 40-Year-Old StoryHistorically, motion-mode (M-mode) echocardiography was the first effective modality for the ultrasonic detection of early pre-ejection events, concomitant with the delta wave in WPW syndrome. Because of its high temporal resolution (1000-3000 Hz), M-mode echocardiography can display the reduced amplitude of left ventricle (LV) posterior systolic wall motion for AP, emerging from LV basal free wall. This modality can also display rapid pre-ejection posterior septal motion associated with a slow anterior motion of the septum for AP, emerging from the right ventricular (RV) free wall.2 Twenty years later, pulsed-wave tissue doppler imaging (TDI) and high frame-rate tissue velocity imaging enabled AP-accurate localization in 50% more patients, when compared with the M-mode method.2 High temporal resolution (at least 150 Hz) is a potential advantage of TDI; however, clinical use was limited by artifacts, caused by myocardial translational motion, nonoptimal Doppler alignment, and poor reproducibility.Approximately 10 years ago, 2-dimensional speckletracking echocardiography gained popularity in quantification of amplitude and timing of myocardial deformation, with a lower influence of cardiac motion as compared with TDI. Optimal frame rate for speckle-tracking echocardiography is 50 to 90 Hz, a much lower rate than that of M-mode or TDI. Nevertheless, using customized software, De Boeck's team demonstrated that speckle-tracking echocardiography mapping matched the electrophysiology localization (with a tolerance of 1 contiguous segment) of the AP in 28 patients (85%) with a WPW syndrome. 4 Importantly, early deformation associated with the AP was subsequently followed by reduced local deformation during systole, especially in patients with AP involving the interventricular septum (IVS). In a cohort of 40 patients with WPW syndrome referred for radiofrequency ablation, longitudinal speckle-tracking echocardiography strain accurately identified early basal pre-ejection LV deformation in 38 patients (95%), 5 w...

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“…[4][5][6] Recently, an accessory pathway has been reported to contribute to LV septal dyskinesia and LV dysfunction in the absence of documented SVT. [7][8][9][10][11] Many patients exhibit right septal or posteropesptal accessory pathways. Herein, we report a case of WPW syndrome with right-sided free-wall accessory pathway and LV dysfunction.…”

Section: Introductionmentioning

confidence: 99%

An Asymptomatic Case of Wolff‐Parkinson‐White Syndrome with Right‐sided Free‐wall Accessory Pathway and Left Ventricular Dysfunction

Mine

Kodani

Hamaoka

et al. 2011

Journal of Arrhythmia

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A 16-year-old girl with a known history of asymptomatic Wolff-Parkinson-White syndrome exhibited signs of left ventricular (LV) septal akinesia and LV dysfunction during routine follow-up. A 12-lead surface ECG showed pre-excitation, a predominantly negative delta wave in V 1 and left axis deviation, which was consistent with the presence of a right free-wall accessory pathway. Radiofrequency ablation of the anterolateral right atrium around the local shortest atrium-to-ventricle interval created the accessory pathway block. An echocardiogram taken one month after the procedure revealed that LV septal wall motion had normalized and that LV ejection fraction had improved from 50% before the ablation to 64% after the ablation. Most previous reports of asymptomatic patients of WPW with LV septal dyskinesia and dysfunction have described right septal or posteroseptal accessory pathways. This patient reported here represents a rare case with right free-wall accessory pathway and LV dysfunction without tachycardia. (J Arrhythmia 2011; 27: 145-149)

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Septal Dyskinesia and Global Left Ventricular Dysfunction in Pediatric Wolff‐Parkinson‐White Syndrome with Septal Accessory Pathway

Abstract: The dyskinetic segment activated by a right septal AP in WPW syndrome may lead to ventricular dilation and dysfunction. RFA produced mechanical resynchronization, reverse remodeling, and improvements in LV function.

Cited by 69 publications

References 22 publications

Radiofrequency Catheter Ablation of the Accessory Pathway Adversely Affected the Left Ventricular Outflow Tract Pressure Gradient in a Patient With Hypertrophic Obstructive Cardiomyopathy

Radiofrequency Catheter Ablation of the Accessory Pathway Adversely Affected the Left Ventricular Outflow Tract Pressure Gradient in a Patient With Hypertrophic Obstructive Cardiomyopathy

The Wolff–Parkinson–White Syndrome

An Asymptomatic Case of Wolff‐Parkinson‐White Syndrome with Right‐sided Free‐wall Accessory Pathway and Left Ventricular Dysfunction

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