A Rare Case Report Wolff-Parkinson-White Syndrome and Pre-excitation Induced Cardiomyopathy: Is It a Causal or Casual Relationship?
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Abstract
Background
Patients with Wolff-Parkinson-White (WPW) syndrome frequently experience palpitations due to atrioventricular reciprocating tachycardia (AVRT) associated with an accessory pathway (AP). The specific mechanism underlying left ventricular (LV) dysfunction in individuals with pre-excitation syndrome is not fully understood, and its prevalence in Indonesia is also unclear. Eccentric activation of the ventricles through an AP—especially if located on the right side—can cause an asynchronous spread of ventricular depolarization. This leads to both mechanical and electrical dyssynchrony, which may worsen LV dysfunction, a condition known as Pre-excitation Induced Cardiomyopathy (PIC). This case report aims to investigate the impact of a right-sided AP in pre-excitation syndrome that results in PIC, and to discuss the outcomes of successful right AP ablation in enhancing LV systolic function in our patient at the National Cardiovascular Center Harapan Kita (NCCHK).
Case Illustration
A 12-year-old female patient with WPW syndrome and chronic heart failure symptoms presented to NCCHK. An echocardiogram indicated non-ischaemic cardiomyopathy with an initial left ventricular ejection fraction (LVEF) of 18% and global hypokinesia. A 12-lead electrocardiogram (ECG) revealed a pre-excitation pattern on the right anterior side. During radiofrequency ablation (RFA), the accessory pathway (AP) was located in the right anterior area, consistent with the ECG findings. The ablation procedure was successfully completed. One year post-ablation, the patient’s LVEF gradually improved to 41%.
Summary
The patient's cardiomyopathy was likely a result of left ventricular dyssynchrony caused by significant ventricular pre-excitation. After successful ablation of the right anterior AP, the patient has not experienced any major heart failure symptoms. Continuous long-term follow-up, particularly for clinical and echocardiographic evaluations, is still needed. To date, the patient's left ventricular ejection fraction (LVEF) has improved remarkably, and the patient remains free of symptoms.
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