Tachycardia-induced cardiomyopathy in a patient with left-sided accessory pathway and left bundle branch block

Abstract

Rationale: Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP). Patient concerns: A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability. Diagnosis: The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected. Interventions: The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring. Outcomes: One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal. Lessons: AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.

Tachycardiomyopathy: Clinical Profile, Treatment and Outcome of a Series of Clinical Cases

“…Therefore, this series of cases is in accordance with what has been described in the literature regarding the cause of tachycardiomyopathy. Less frequent causes of supraventricular arrhythmias that induce tachycardiomyopathy are permanent junctional re-entrant tachycardia, atrioventricular tachycardia, nodal tachycardia with simultaneous antegrade conduction through fast and slow atrioventricular nodal pathways [1,[9][10][11].…”

Combination of electrophysiological mapping, RFCA, and atrial appendectomy in a 5-year- old girl with tachycardia-induced cardiomyopathy: A case report

“…Intravenous injection of deslanoside and diuretics and oral captopril was initially started for rate control, but it remained uncontrolled maintained at 160 beats / min. RFCA was considered after obtaining informed consent due to the poor cardiac function of this patient (2,4,5) . A 6F-decapolar and a 6Fquadripolar catheter were advanced into the coronary sinus and right ventricular apex via the left subclavian vein and right femoral vein, respectively.…”

Malignant ventricular arrhythmias and other complications of untreated accessory pathways: an analysis of prevalence and risk factors in over 600 ablation cases

“…Other possible mechanisms for heart failure due to tachycardia -induced cardiomyopathy are chronic AF with preexcitation and incessant AVRT (2 cases in our cohort). 21,22 asymptomatic individual due to confirmed VF; all other patients survived malignant arrhythmia episodes. However, we believe that the relatively high percentage of survivors seen both in our and in other studies on preexcitation cannot be considered as an argument in favor of withholding ablation in asymptomatic patients, as suggested by some investigators.…”