[CRT-FORUM] 58E Preexcitation and dilated cardiomyopathy in elderly woman. Dr. Perez Riera

[CRT-INFO]

CONGESTIVE HEART FAILURE IN A PATIENT WITH WOLFF PARKINSON WHITE SYNDROME:
CASE REPORT

Dear Dr. Alberto Morales Salinas, from the fantastic and beautiful Cuba:
Your case report have several similarities with the cases reports presented
by Yamanaka et al (1) and recently by Iwasaku et al(2). In the first one, a
67-year-old man was admitted to hospital for the treatment dyspnea on
exertion. He suffered from CHF due to an old inferior myocardial infarction
with type B WPW syndrome. Asynchronous wall motion caused by pre-excitation
through a right-sided accessory pathway (AP) caused his cardiac function to
deteriorate. Because asynchronous septal motion caused by pre-excitation
through a right-sided AP might deteriorate his cardiac performance, RFCA to
the AP was performed. RFCA of the AP increased the EF, and improved his
symptoms, prior to surgical revascularization.
In the second recent case report (Iwasaku et al. 2009), successful procedure
after 17 months improved LV contraction, reduced LV volume, and decreased
mitral regurgitation and BNP.
In similar hemodynamic conditions the occasionally observed progressive CHF
after RV pacing following His-bundle ablation can be reversed by upgrading
to VVIR biventricular pacing and under these circumstances upgrading should
be considered (3).
Dear Alberto, I think that your case report is interesting for submit to
indexed Journal.

Reference
1) Yamanaka S, Shirayama T, Inoue K, Kawata K, Yagi T, Azuma A, Inoue
D, Nakagawa M. Improved cardiac function after catheter ablation in a
patient with type B Wolff-Parkinson-White syndrome with an old myocardial
infarction. Jpn Circ J. 1998 Nov; 62: 860-822.

2) Iwasaku T, Hirooka K, Taniguchi T, Hamano G, Utsunomiya Y, Nakagawa
A, Koide M, Ishizu T, Yamato M, Sasaki N, Yamamoto H, Kawaguchi Y, Mizuno H,
Koretsune Y, Kusuoka H, Yasumura Y. Successful catheter ablation to
accessory atrioventricular pathway as cardiac resynchronization therapy in a
patient with dilated cardiomyopathy. Europace. 2009 Jan; 11: 121-123.

3) Erol-Yilmaz A, Tukkie R, Schrama TA, Romkes HJ, Wilde AA.Reversed
remodelling of dilated left sided cardiomyopathy after upgrading from VVIR
to VVIR biventricular pacing. Europace. 2002 Oct; 4: 445-449.

All the best for all
Andrés Ricardo Pérez Riera.MD
Chief of electrovectorcardiographic sector. ABC’s Medical School, ABC
Foundation, Santo André, São Paulo, Brazil Riera at uol.com.br
> Dear colleagues of the CRT symposium,
> The debates are very interesting. Congratulations to the organizers of 
> the
> forum. I would like to share with you the following case:
> Fifteen days ago, I received a woman in my office, with 60 something 
> years,
> with history of apparent health until around three months ago, when she
> starts to experience maintained palpitations and besides "languidness" 
> with
> light strain. In the physical examination: gallop rhythm, 
> non-crepitant, HR:
> 110x minute, BP: 120/80 mmHg and in the ECG, ventricular preexcitation
> (possibly with right-anterior location). Functional class 3 of NYHA.
> When questioned, she denied having personal history of angor, or sudden
> dyspnea related to possible ischemic heart diseases; neither onset
> palpitations crises nor sudden onset, or different from the current 
> clinical
> symptoms which would make us think of PSVT by accessory pathway. In
> transthoracic Echo, LV in diastole 68 mm, moderate mitral valve
> insufficiency, EF <35%.
> I think that we cannot rule ischemia yet, or tachycardiomyopathy 
> secondary
> to orthodromic tachycardia as causes for the clinical symptoms.
> Regardless of the cause, the hemodynamics of the patient would benefit 
> much
> from the pharmacological control of the HR: but digoxin, amiodarone,
> anticalcium agents (verapamil) and beta blockers are contraindicated if
> there is suspicion of tachycardia by this pathway.
> According to some authors, beta blockers besides decreasing the 
> conduction
> velocity of the AV node, may also decrease the velocity of this 
> pathway, so
> maybe they are the lesser evil in terms of drug options. There are also
> studies that support this, that show the benefits from beta blocking 
> on HF
> survival with severely depressed EF. On the other hand, IC drugs, due 
> to a
> poor ventricular function, are also dismissed. The patient is now 
> undergoing
> a study. This is an atypical case. What is your advice?
>
> Best regards,
> Alberto Morales Salinas. Cuba
> Cardiologo
> cardioams at yahoo.es
>


-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee