Wolff-Parkinson-White syndrome induced cardiomyopathy
█ Case report
Schvartz Noémi, Kohári Mária, Kupó Péter, Pap Róbert
Szegedi Tudományegyetem ÁOK, II. sz. Belgyógyászati Klinika és Kardiológiai Központ, Aritmológiai Részleg, Szeged
Wolff-Parkinson-White (WPW) syndrome is associated with dilated cardiomyopathy (DCM). Frequent and prolonged tachycardia episodes can lead to tachycardia-induced cardiomyopathy resulting in increased end-diastolic pressure and dilation of the left ventricle. In some cases, preexcitation via an accessory pathway can lead to dyssynchrony and dyskinesia causing left ventricular dysfunction.
A 27-year old man was admitted to the emergency department because of short palpitations and chest discomfort. 12-lead ECG showed sinus rhythm with narrow QRS-complex alternating with sinus rhythm with left bundle branch block-like pre-excited QRS-complex. Transthoracic echocardiography proved decreased left ventricle function (EF=40%) with septal and anterior akinesis. Because of the preexcitation seen on the ECG, the patient was scheduled for an electrophysiologic study that showed an anterograde anteroseptal accessory pathway. Considering the localization of the accessory pathway cryoablation was performed, consequently, activation via the accessory pathway ceased. After the procedure, control echocardiography was performed that showed improvement in the left ventricular function (EF=55%).
WPW syndrome seldom leads to left ventricular dysfunction, mainly in case of a septal accessory pathway. Activation via an accessory pathway causes septal preexcitation, which can lead to dyssynchrony and decreased left ventricular function. After successful catheter ablation of the accessory pathway dyssynchrony ceases and left ventricular function can improve.