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Case Reports
. 2010;37(4):483-5.

Reversion of left ventricular systolic dysfunction and abnormal stress test: by catheter ablation, in a patient with Wolff-Parkinson-White syndrome from Para-Hisian Kent bundle

Chung-Ming Tu  1 , Kai-Ming Chu, Cheng-Chung Cheng, Shu-Mung Cheng, Wei-Shiang Lin
Affiliations
Case Reports

Reversion of left ventricular systolic dysfunction and abnormal stress test: by catheter ablation, in a patient with Wolff-Parkinson-White syndrome from Para-Hisian Kent bundle

Chung-Ming Tu et al. Tex Heart Inst J. 2010.

Abstract

The diagnosis of Wolff-Parkinson-White syndrome is typically reserved for patients who experience ventricular pre-excitation and symptoms that are related to paroxysmal supraventricular tachycardia, such as chest pain, dyspnea, dizziness, palpitations, or syncope. Herein, we report the case of a 38-year-old woman who presented at our outpatient department because of exercise intolerance. Cardiac auscultation revealed a grade 2/6 pansystolic murmur over the left lower sternal border. Twelve-lead electrocardiography showed sinus rhythm at a rate of 76 beats/min, with a significant delta wave. Transthoracic echocardiography revealed abnormal left ventricular systolic function. The results of a thallium stress test were also abnormal. Coronary artery disease was suspected; however, coronary angiography yielded normal results. Electrophysiologic study revealed a para-Hisian Kent bundle and a dual atrioventricular nodal pathway. After radiofrequency catheter ablation was performed, the patient's left ventricular function improved and her symptoms disappeared. In Wolff-Parkinson-White syndrome, left ventricular systolic dyssynchrony can yield abnormal findings on echocardiography and thallium scanning--even in persons who have no cardiovascular risk factors. Physicians who are armed with this knowledge can avoid performing coronary angiography unnecessarily. Catheter ablation can reverse the dyssynchrony of the ventricle and improve the patient's symptoms.

Keywords: Diagnosis, differential; Wolff-Parkinson-White syndrome/diagnosis/physiopathology/radionuclide imaging; echocardiography; electrophysiology; heart conduction system/physiopathology; heart ventricles/physiopathology; myocardial contraction; treatment outcome.

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Figures

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Fig. 1 Twelve-lead electrocardiogram shows sinus rhythm (heart rate, 75 beats/min) and a significant delta wave.
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Fig. 2 M-mode echocardiogram reveals global hypokinesia of the left ventricle (ejection fraction, 0.40).
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Fig. 3 Five months after radiofrequency catheter ablation, an M-mode echocardiogram reveals a normal left ventricle (ejection fraction, 0.55).
See this image and copyright information in PMC

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