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Case Reports
. 2023 Mar;28(2):e13001.
doi: 10.1111/anec.13001. Epub 2022 Aug 8.

Resolution of severe cardiomyopathy after catheter ablation of an anteroseptal accessory pathway: A case report

Omar J Baqal  1 , Vatsal M Ladia  2 , Hicham El Masry  3
Affiliations
Case Reports

Resolution of severe cardiomyopathy after catheter ablation of an anteroseptal accessory pathway: A case report

Omar J Baqal et al. Ann Noninvasive Electrocardiol. 2023 Mar.

Abstract

In patients with non-sustained tachyarrhythmias, left ventricular (LV) systolic dysfunction is uncommon. The role of catheter ablation (CA) in asymptomatic patients with tachyarrhythmia remains unclear. We report a 20-year-old patient without sustained tachyarrhythmia with a left ventricular ejection fraction of 20% who underwent radiofrequency catheter ablation (RFCA) of anteroseptal accessory pathway. She achieved normalization of left ventricular systolic function noted on echocardiography performed at 4 weeks post-ablation. Our case highlights significant improvement in LV systolic function after catheter ablation of an "asymptomatic" ventricular pre-excitation. Current guidelines do not endorse ablating asymptomatic patients, but careful follow-up with serial echocardiograms might be warranted. Prophylactic ablation of those patients with clear evidence of LV dyssynchrony or wide left bundle branch pattern and persistent pre-excitation is worth further consideration.

Keywords: accessory pathway; cardiomyopathy; case report; catheter ablation; tachyarrhythmia.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Baseline ECG demonstrating pre‐excitation consistent with anteroseptal pathway.
FIGURE 2
FIGURE 2
(a) Site of successful ablation: Ablation catheter demonstrating atrial ventricular and a pathway potential that is uncovered by an atrial extrastimulus (S2). ABL, ablation; CS, coronary sinus; D, distal; P, proximal; RVA, right ventricular apex. (b) Loss of pre‐excitation 20 seconds after initiation of cryoablation.
FIGURE 3
FIGURE 3
ECG on 3‐month post‐ablation follow‐up demonstrating loss of pre‐excitation and normalization of the QRS complex.
See this image and copyright information in PMC

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