Improvement in Dyssynchrony with Pharmacological Ablation of Right-Sided Accessory Pathway-Induced Cardiomyopathy in Infants

Abstract

Right-sided accessary pathways in patients with Wolff-Parkinson-White (WPW) syndrome may cause cardiac dyssynchrony and dilated cardiomyopathy, with a characteristic septal shape, irrespective of any supraventricular tachycardia episodes. We report on two infants (13 and 5 months), whose right-sided accessary pathway-induced dilated cardiomyopathy was successfully treated by flecainide for the first time. After the flecainide administration, an abnormal aneurysmal dilation of the basal interventricular septum was almost restored to normal, and the decreased ejection fraction recovered. Flecainide use may be an important therapeutic option for this entity to avoid catheter ablation during infancy.(Int Heart J 2019; 60: 1201-1205)

Ablation of Ventricular Preexcitation to Cure Preexcitation-Induced Dilated Cardiomyopathy in Infants: Diagnosis and Outcome

“…However, the number of cases in these studies was small with uncertain efficacy. 5,6 Three patients in the present study had been treated with oral amiodarone for 14 to 30 days before RFCA with no efficacy. The potential hepatic and thyroid toxicity of amiodarone limits its use in infants with immature organs function.…”

“…4 Treatment with amiodarone, flecainide, or propafenone has been reported with inconclusive effects. 5,6 Although radiofrequency ablation (RFCA) could fundamentally improve the prognosis by successfully blocking ventricular preexcitation, the difficulty of ablation is much greater than that of children and adults due to factors such as small infant weight, small blood vessels, small heart chambers, high proportion of multiple pathways, and the risk of para-His pathway ablation. Therefore, this study aimed to investigate the clinical features, evaluate safety, and efficacy of RFCA for preexcitation-induced DCM in infants, and to aid the early diagnosis and therapeutic interventions for these patients.…”

Perspective of preexcitation induced cardiomyopathy; early septal contraction, and subsequent rebound stretch

“…The dyskinesis of the interventricular septum at mid-systole was a frequent finding in 38 of 42 patients (90%). [13] ). (A) Aneurysmal dilation at the base of the interventricular septum seen in a 13-month-old male infant.…”

“…Fig.6. A typical example of mechanical abnormality and morphological degeneration in preexcitation-induced cardiomyopathy (Sekine et al[13] ). (A) Aneurysmal dilation at the base of the interventricular septum seen in a 13-month-old male infant.…”

WPW Syndrome: Review of the Evidence

“…If possible, measures such as marking and Catheter observation for proper catheter movement and passage, observation of plasma markers such as troponin, after ablation, and to ensure the presence or absence of possible damage and even to prevent catheter passage, used vessels with a diameter of less than 5mm. The incidence of such errors is very low and, for example, in one study, the incidence of coronary artery damage during ablation was reported to be around 0.09% [84] ; However, with all the reported risk factors and even with the possibility of av block due to the sudden death of cardiac cells and other risks of this disease, cryo or RF surgery is required, [85] the use of marking systems With advanced 3D mapping to find the exact signs of side paths, it can greatly contribute to the success of the surgery [75]. Also, in patients with venous occlusion problems or anatomical problems or even pregnancy, performing this surgery can face challenges.…”