Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Left Ventricular Dysfunction and Dilated Cardiomyopathy in Infants and Children with Wolff-Parkinson-White Syndrome in the Absence of Tachyarrhythmias

  • Ko, JaeKon (Division of Pediatric Cardiology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • Published : 2012.12.31
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Abstract

Left ventricular (LV) dysfunction and dilated cardiomyopathy (DCM) are rarely attributable to sustained or incessant tachyarrhythmias in infants and children with Wolff-Parkinson-White (WPW) syndrome. However, several recent reports suggested that significant LV dysfunction may develop in WPW syndrome in the absence of tachyarrhythmias. It is assumed that an asynchronous ventricular activation over the accessory pathway, especially right-sided, induces septal wall motion abnormalities, ventricular remodeling and ventricular dysfunction. The prognosis of DCM associated with asymptomatic WPW is excellent. Loss of ventricular pre-excitation results in mechanical resynchronization and reverse remodeling where LV function recovers completely. The reversible nature of LV dysfunction after loss of ventricular pre-excitation supports the causal relationship between LV dysfunction and ventricular pre-excitation. This review summarizes recent clinical and electrophysiological evidence for development of LV dysfunction or DCM in asymptomatic WPW syndrome, and discusses the underlying pathophysiological mechanism.

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References

  1. Fenelon G, Wijns W, Andries E, Brugada P. Tachycardiomyopathy: mechanisms and clinical implications. Pacing Clin Electrophysiol 1996;19:95-106. https://doi.org/10.1111/j.1540-8159.1996.tb04796.x
  2. Horenstein MS, Saarel E, Dick M, Karpawich PP. Reversible symptomatic dilated cardiomyopathy in older children and young adolescents due to primary non-sinus supraventricular tachyarrhythmias. Pediatr Cardiol 2003;24:274-9. https://doi.org/10.1007/s00246-002-0274-5
  3. Yamanaka S, Shirayama T, Inoue K, Kawata K, Yagi T, Azuma A, et al. Improved cardiac function after catheter ablation in a patient with type B Wolff-Parkinson-White syndrome with an old myocardial infarction. Jpn Circ J 1998;62:860-2. https://doi.org/10.1253/jcj.62.860
  4. Emmel M, Balaji S, Sreeram N. Ventricular preexcitation associated with dilated cardiomyopathy: a causal relationship? Cardiol Young 2004;14:594-9. https://doi.org/10.1017/S1047951104006031
  5. Fazio G, Mongiovi' M, Sutera L, Novo G, Novo S, Pipitone S. Segmental dyskinesia in Wolff-Parkinson-White syndrome: a possible cause of dilatative cardiomyopathy. Int J Cardiol 2008;123:e31-4. https://doi.org/10.1016/j.ijcard.2006.11.109
  6. Cadrin-Tourigny J, Fournier A, Andelfinger G, Khairy P. Severe left ventricular dysfunction in infants with ventricular preexcitation. Heart Rhythm 2008;5:1320-2. https://doi.org/10.1016/j.hrthm.2008.05.022
  7. Tomaske M, Janousek J, Razek V, et al. Adverse effects of Wolff-Parkinson-White syndrome with right septal or posteroseptal accessory pathways on cardiac function. Europace 2008;10:181-9. https://doi.org/10.1093/europace/eun005
  8. Iwasaku T, Hirooka K, Taniguchi T, et al. Successful catheter ablation to accessory atrioventricular pathway as cardiac resynchronization therapy in a patient with dilated cardiomyopathy. Europace 2009;11:121-3.
  9. Kwon BS, Bae EJ, Kim GB, Noh CI, Choi JY, Yun YS. Septal dyskinesia and global left ventricular dysfunction in pediatric Wolff-Parkinson-White syndrome with septal accessory pathway. J Cardiovasc Electrophysiol 2010;21:290-5. https://doi.org/10.1111/j.1540-8167.2009.01612.x
  10. Udink ten Cate FE, Kruessell MA, Wagner K, et al. Dilated cardiomyopathy in children with ventricular preexcitation: the location of the accessory pathway is predictive of this association. J Electrocardiol 2010;43:146-54. https://doi.org/10.1016/j.jelectrocard.2009.09.007
  11. Marti-Almor J, Bazan V, Morales M, Guerra JC. [Heart failure in a patient with Wolff-Parkinson-White syndrome]. Rev Esp Cardiol 2011;64:1217-8. https://doi.org/10.1016/j.recesp.2011.01.013
  12. Udink Ten Cate FE, Wiesner N, Trieschmann U, Khalil M, Sreeram N. Dyssynchronous ventricular activation in asymptomatic wolff-Parkinsonwhite syndrome: a risk factor for development of dilated cardiomyopathy. Indian Pacing Electrophysiol J 2010;10:248-56.
  13. DeMaria AN, Vera Z, Neumann A, Mason DT. Alterations in ventricular contraction pattern in the Wolff-Parkinson-White syndrome. Detection by echocardiography. Circulation 1976;53:249-57. https://doi.org/10.1161/01.CIR.53.2.249
  14. Francis GS, Theroux P, O'Rourke RA, Hagan AD, Johnson AD. An echocardiographic study of interventricular septal motion in the Wolff-Parkinson-White syndrome. Circulation 1976;54:174-8. https://doi.org/10.1161/01.CIR.54.2.174
  15. Ticzon AR, Damato AN, Caracta AR, Russo G, Foster JR, Lau SH. Interventricular septal motion during preexcitation and normal conduction in Wolff-Parkinson-White syndrome: echocardiographic and electro-physiologic correlation. Am J Cardiol 1976;37:840-7. https://doi.org/10.1016/0002-9149(76)90107-7
  16. Lebovitz JA, Mandel WJ, Laks MM, Kraus R, Weinstein S. Relationship between the electrical (electrocardiographic) and mechanical (echocardiographic) events in Wolff-Parkinson-White syndrome. Chest 1977;71:463-9. https://doi.org/10.1378/chest.71.4.463
  17. Grines CL, Bashore TM, Boudoulas H, Olson S, Shafer P, Wooley CF. Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. Circulation 1989;79:845-53. https://doi.org/10.1161/01.CIR.79.4.845
  18. Prinzen FW, Cheriex EC, Delhaas T, et al. Asymmetric thickness of the left ventricular wall resulting from asynchronous electric activation: a study in dogs with ventricular pacing and in patients with left bundle branch block. Am Heart J 1995;130:1045-53. https://doi.org/10.1016/0002-8703(95)90207-4
  19. Tantengco MV, Thomas RL, Karpawich PP. Left ventricular dysfunction after long-term right ventricular apical pacing in the young. J Am Coll Cardiol 2001;37:2093-100. https://doi.org/10.1016/S0735-1097(01)01302-X
  20. Thambo JB, Bordachar P, Garrigue S, et al. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 2004;110:3766-72. https://doi.org/10.1161/01.CIR.0000150336.86033.8D
  21. Prinzen FW, Peschar M. Relation between the pacing induced sequence of activation and left ventricular pump function in animals. Pacing Clin Electrophysiol 2002;25(4 Pt 1):484-98.
  22. De Boeck BW, Teske AJ, Leenders GE, et al. Detection and quantification by deformation imaging of the functional impact of septal compared to free wall preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 2010;106:539-46. https://doi.org/10.1016/j.amjcard.2010.03.066
  23. Kugler JD, Danford DA, Houston KA, Felix G; Pediatric Radiofrequency Ablation Registry of the Pediatric Radiofrequency Ablation Registry of the Pediatric Electrophysiology Society. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002;13:336-41. https://doi.org/10.1046/j.1540-8167.2002.00336.x
  24. Saul JP, Hulse JE, Papagiannis J, Van Praagh R, Walsh EP. Late enlargement of radiofrequency lesions in infant lambs. Implications for ablation procedures in small children. Circulation 1994;90:492-9. https://doi.org/10.1161/01.CIR.90.1.492

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