The manifest right accessory pathway led to reversible left ventricular dyssynchrony and dysfunction

摘要

We report observations in a 7 year old girl with manifest right accessory pathway (AP) and depressed cardiac function. Her Echocardiogram showed LV dilatation with asynchronous ventricular wall motion and LVEF reduction. The electrophysiological study demonstrated a para-his AP. She underwent successfully ablation and without any complications. The Echo validated that asynchronous ventricular wall motion disappeared after ablation. Her cardiac size and function was normal after follow up of three month. Our findings suggested that manifest AP leading to asynchronous ventricular motion was a possible cause of left ventricular dilation and dysfunction. Catheter ablation could reverse cardiac remodeling in such patient. Case report A seven year old girl was referred to our hospital for fainting episode in last six month. To exclude cephalic syncope, she underwent electroencephalogram, the result was negative. The electrocardiogram (ECG) showed right AP. An apparent delta wave looked like LBBB pattern with short PR interval (80ms) and long QRS duration (180ms) (figure 1 left panel). Echocardiogram (Echo) revealed left ventricle dilatation and left ventricular ejection fraction reduction (LVDd=52mm, LVEF=46%). Asynchronous ventriclular wall motion and moderate mitral valve regurgitation also observed on Tissue Doppler Imaging (TDI). She underwent electrophysiology study (EPS) and ablation procedure on the 5th hospital day. The intracardiac electrogram showed a para-His AP with antegrade conduction. The orthodromic SVT (201 bpm) was induce right ventricular apex programmed stimulation. During SVT episode, her symptom was similar to spontaneous one. After successful ablation, delta wave on ECG disappeared and SVT can not be induced with or without isoproterenol. Normal atrial-ventricular conduction was kept without any complications. Prior to discharge, Echo showed the LVEF slightly improved and TDI indicated that asynchronous ventricular wall motion disappeared. She was discharged without any medication.