[CRT-FORUM] 60S Pre-exitation and dilated cardiomyopathy in elderly woman. Dr. Cagnolatti

[CRT-INFO]

Dear colleague,
Although I have understood the interesting case that you commented, I think
we should differentiate between two things: one, whether on the ECG there is
pre-excitation during tachycardia, in which case we are before an antidromic
tachycardia, and if this leads to a right location, we should think on
(mahaim) fibers, which is the most likely case if there is image of left
bundle branch during the tachycardia.
Anyway, I think it is imperative to rule out ischemia, and undoubtedly if
the patient presents initially with pre-excitation tachycardia, conduct an
electrophysiologic study that would help us to solve a problem permanently
by ablation, i.e. the tachycardia problem, which would enable two things:
one, drug management for her heart failure and assessing the evolution of
her remodeling by echo.
Alfredo Cagnolatti
> 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 

-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee