[CRT-FORUM] 65S Preexcitation and dilated cardiomyopathy in elderly woman. Dr. Freire

[CRT-INFO]

Dear colleagues,
The discussions and contributions to the Forum are always very interesting.
About this case, there are several publications of isolated cases that show
that the accessory pathway with a right location may determine systolic
dysfunction by left ventricle dyssynchrony. Once the ablation is made, the
correction of dyssynchrony and LVEF normalization are targeted. This case
presented by our colleague could be similar. Now we have a case of a young
woman with severe systolic dysfunction and right lateral accessory pathway,
with whom we have coordinated for ablation in the following week. As soon as
I have news on the evolution I will send you the data. I attach
bibliographical data. I hope these contributions could be useful.
Kind regards,

Dr. Diego Freire
Prof. Adj. Depto de Cardiología
Hospital de Clinicas
Montevideo. Uruguay

1. Ventricular preexcitation associated with dilated cardiomyopathy: a
causal relationship?
Mathias Emmela1, Seshadri Balaji a2 and Narayanswami Sreeram. Cardiology
in the Young (2004), 14:6:594-599 .

2. Successful catheter ablation to accessory atrioventricular pathway as
cardiac resynchronization therapy in a patient with dilated cardiomyopathy.
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. Europace. 2009 Jan;11(1):121-3.
Epub 2008 Nov 20. 2008 Jan 11;123(2):e31-4

3. Segmental dyskinesia in Wolff-Parkinson-White syndrome: a possible
cause of dilatative cardiomyopathy.
Fazio G, Mongiovi' M, Sutera L, Novo G, Novo S, Pipitone S. Int J
Cardiol. 2008 Jan 11;123(2):e31-4.

4. Adverse effects of Wolff-Parkinson-White syndrome with right septal
or posteroseptal accessory pathways on cardiac function.
Tomaske M, Janousek J, Rázek V, Gebauer RA, Tomek V, Hindricks G,
Knirsch W, Bauersfeld U. Europace. 2008 Feb;10(2):181-9.

5. Reversible left ventricular dyssynchrony and dysfunction resulting
from right ventricular pre-excitation.
Shan Q, Jin Y, Cao K. Europace. 2007 Aug;9(8):697-701.

6. An echocardiographic study of interventricular septal motion in the
Wolff-Parkinson-White syndrome.
Francis GS, Theroux P, O'Rourke RA, Hagan AD, Johnson AD. Circulation.
1976 Aug;54(2):174-8
> 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 


-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee