Successful catheter ablation to accessory atrioventricular pathway as cardiac resynchronization therapy in a patient with dilated cardiomyopathy

Iwasaku, Toshihiro; Hirooka, Keiji; Taniguchi, Takao; Hamano, Go; Utsunomiya, Yukari; Nakagawa, Akito; Koide, Masaaki; Ishizu, Takamaru; Yamato, Masaki; Sasaki, Noriko; Yamamoto, Hiroyoshi; Kawaguchi, Yoshihiro; Mizuno, Hiroya; Koretsune, Yukihiro; Kusuoka, Hideo; Yasumura, Yoshio

doi:10.1093/europace/eun318

Cited by 33 publications

(29 citation statements)

References 5 publications

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“…[7][8][9][10][11] with WPW syndrome with a right-sided free-wall accessory pathway and dilated cardiomyopathy (DCM), in which LV function improved following RF ablation. 12) In patients with decreased LV cardiac function, such as those with DCM, LV dyssynchrony can further compromise cardiac function. By contrast, the present case is relatively unqiue in that right-sided free-wall accessory pathway and LV dysfunction was present in the absence of structural heart disease.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…WPW syndrome with right septal or posteroseptal accessory pathways causes early septal mechanical activation and may be associated with LV systolic dyssynchrony and dysfunction [17]. These functional abnormalities can be reversed after radiofrequency catheter ablation [17,57], which can markedly improve LV EF in patients with dilated cardiomyopathy in the absence of a history of tachycardia [58,59]. Therefore, one may consider ablation of accessory pathways in patients with WPW syndrome and LV dyssynchrony with systolic dysfunction even without history of documented tachycardia episodes [58,60].…”

Section: Cardiac Abnormalities In Wpw Syndromementioning

confidence: 99%

“…These functional abnormalities can be reversed after radiofrequency catheter ablation [17,57], which can markedly improve LV EF in patients with dilated cardiomyopathy in the absence of a history of tachycardia [58,59]. Therefore, one may consider ablation of accessory pathways in patients with WPW syndrome and LV dyssynchrony with systolic dysfunction even without history of documented tachycardia episodes [58,60]. Recently, De Boeck used speckle tracking mapping technique to localize accessory pathway and estimate its effect on local and global ventricular function.…”

Section: Cardiac Abnormalities In Wpw Syndromementioning

confidence: 99%

The use of echocardiography in Wolff–Parkinson–White syndrome

Cai

Shuraih

Nagueh

2011

Int J Cardiovasc Imaging

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Endocardial mapping and radiofrequency catheter ablation are well established modalities for the diagnosis and treatment of patients with Wolff-Parkinson-White (WPW) syndrome associated with tachyarrhythmias. However, the electrophysiologic techniques are invasive, require radiation exposure, and lack spatial resolution of cardiac structures. A variety of echocardiographic techniques have been investigated as a non-invasive alternative for accessory pathway localization. Conventional M-mode echocardiography can detect the fine premature wall motion abnormalities associated with WPW syndrome. However, it is unable to identify the exact site of accessory pathway with sufficient accuracy. 2D, 2D-guided M-mode, and 2D phase analysis techniques are limited by image quality and endocardial border definition. Various modalities of tissue Doppler echocardiography significantly increase the accuracy of left-sided accessory pathway localization to 80-90% even in patients with poor acoustic window. However, right-sided pathways remain a diagnostic challenge. Strain echocardiography by speckle tracking has recently been evaluated and appears promising. Different cardiac abnormalities have been detected by echocardiography in WPW patients. Patients with WPW syndrome and tachyarrhythmias have impaired systolic and diastolic function which improves after radiofrequency ablation. Echocardiography is useful in identifying patient with accessory pathway-associated left ventricular dyssynchrony and dysfunction who may benefit from ablation therapy. Transesophageal and intracardiac echocardiography have been used to guide ablation procedure. Ablation-related complications detected by routine echocardiography are infrequent, rarely clinically relevant, and of limited value.

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“…4)5) Preexcitation by an AP is associated with decreased left ventricular function, depending on the location of the AP 5). Patients with a right-sided AP, with preexcitation, have more severe cardiac dysfunction 5-8). It is well known that in most patients, cardiac function improves and reverse remodeling initiates after preexcitation stops 6-8).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with a right-sided AP, with preexcitation, have more severe cardiac dysfunction 5-8). It is well known that in most patients, cardiac function improves and reverse remodeling initiates after preexcitation stops 6-8). The etiology of cardiac dysfunction should be evaluated for the appropriate treatment of DCMP with WPW syndrome.…”

Section: Introductionmentioning

confidence: 99%

Amiodarone and Catheter Ablation as Cardiac Resynchronization Therapy for Children with Dilated Cardiomyopathy and Wolff-Parkinson-White Syndrome

et al. 2013

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Preexcitation by accessory pathways (APs) is known to cause dyssynchrony of the ventricle, related to ventricular dysfunction. Correction of ventricular dyssynchrony can improve heart failure in cases of dilated cardiomyopathy (DCMP) with preexcitation. Here, we report the first case of a child with DCMP and Wolff-Parkinson-White (WPW) syndrome treated with amiodarone and radiofrequency catheter ablation (RFCA) in Korea. A 7-year-old boy, who suffered from DCMP and WPW syndrome, showed improved left ventricular function and clinical functional class after treatment with amiodarone to eliminate preexcitation. QRS duration and left ventricular ejection fraction (LVEF) were inversely correlated with amiodarone dosage. After confirming the reduction of preexcitation effects in DCMP, successful RFCA of the right anterior AP resulted in LVEF improvement, along with the disappearance of preexcitation. Our findings suggest that ventricular dyssynchrony, caused by preexcitation in DCMP with WPW syndrome, can worsen ventricular function and amiodarone, as well as RFCA, which should be considered as a treatment option, even in young children.

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Successful catheter ablation to accessory atrioventricular pathway as cardiac resynchronization therapy in a patient with dilated cardiomyopathy

Cited by 33 publications

References 5 publications

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

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

The use of echocardiography in Wolff–Parkinson–White syndrome

Amiodarone and Catheter Ablation as Cardiac Resynchronization Therapy for Children with Dilated Cardiomyopathy and Wolff-Parkinson-White Syndrome

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