Cardiomyopathy Caused by Right Free-Wall Accessory Pathway

概要

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Previous reports have shown that septal accessory pathways (APs) occasionally cause ventricular dyssynchrony and left ventricular (LV) dysfunction. However, right and left free-wall APs rarely affect LV function. A 52-year old male was admitted to our hospital due to NYHA class-IV heart failure. He had been diagnosed as dilated cardiomyopathy a year ago, and had received optimal medical therapy including ACE inhibitor, beta-blocker, diuretics, spironolactone, and digitalis. His ECG showed wide QRS (180 ms) with delta wave due to Type-B WPW syndrome. His UCG showed marked LV enlargement and dysfunction (LVDD=80 mm, LVEF=10%) with prominent ventricular dyssynchrony. Immediately after successful elimination of the AP located at posterolateral tricuspid annulus by radiofrequency catheter ablation (RFCA), his heart failure symptom markedly improved, and his BNP level decreased from 1392 to 401 (pg/ml). Because of prolonged QRS duration (120 ms) and suspected residual ventricular dyssynchrony by Tissue-Doppler UCG, he underwent CRT-D implantation 3 days after RFCA, although the device was set at DDDR-60 with long AV delay to preserve intrinsic ventricular conduction and excitation. After 6 months, his heart failure status was NYHA class-II. His UCG showed marked LV reverse remodeling (LVDD=52 mm, LVEF=41%), and his BNP level was 24 (pg/ml). This was considered a case of cardiomyopathy caused by ventricular dyssynchrony due to right free-wall AP.