DOI QR코드

DOI QR Code

Amiodarone and Catheter Ablation as Cardiac Resynchronization Therapy for Children with Dilated Cardiomyopathy and Wolff-Parkinson-White Syndrome

  • Kim, Sung Hoon (Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Jeong, Soo In (Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University School of Medicine) ;
  • Huh, June (Department of Pediatrics, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, I-Seok (Department of Pediatrics, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Heung Jae (Department of Pediatrics, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2013.01.30

Abstract

Preexcitation by accessory pathways (APs) is known to cause dyssynchrony of the ventricle, related to ventricular dysfunction. Correction of ventricular dyssynchrony can improve heart failure in cases of dilated cardiomyopathy (DCMP) with preexcitation. Here, we report the first case of a child with DCMP and Wolff-Parkinson-White (WPW) syndrome treated with amiodarone and radiofrequency catheter ablation (RFCA) in Korea. A 7-year-old boy, who suffered from DCMP and WPW syndrome, showed improved left ventricular function and clinical functional class after treatment with amiodarone to eliminate preexcitation. QRS duration and left ventricular ejection fraction (LVEF) were inversely correlated with amiodarone dosage. After confirming the reduction of preexcitation effects in DCMP, successful RFCA of the right anterior AP resulted in LVEF improvement, along with the disappearance of preexcitation. Our findings suggest that ventricular dyssynchrony, caused by preexcitation in DCMP with WPW syndrome, can worsen ventricular function and amiodarone, as well as RFCA, which should be considered as a treatment option, even in young children.

Keywords

References

  1. Campbell RM, Strieper MJ, Frias PA, Collins KK, Van Hare GF, Dubin AM. Survey of current practice of pediatric electrophysiologists for asymptomatic Wolff-Parkinson-White syndrome. Pediatrics 2003;111:e245-7. https://doi.org/10.1542/peds.111.3.e245
  2. Schulze OC, Kammeraad J, Ramanna H, Sreeram N. Catheter ablation for tachyarrhythmia-induced cardiomyopathy in infants. Int J Cardiol 2000;74:99-100. https://doi.org/10.1016/S0167-5273(00)00270-9
  3. Umana E, Solares CA, Alpert MA. Tachycardia-induced cardiomyopathy. Am J Med 2003;114:51-5. https://doi.org/10.1016/S0002-9343(02)01472-9
  4. Niksch AL, Dubin AM. Risk stratification in the asymptomatic child with Wolff-Parkinson-White syndrome. Curr Opin Cardiol 2006;21:205-7. https://doi.org/10.1097/01.hco.0000203182.81534.b0
  5. 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
  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. 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
  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. 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
  10. Yamanaka S, Shirayama T, Inoue K, 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
  11. 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
  12. 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
  13. Hirasawa Y, Nakagomi A, Kobayashi Y, Katoh T, Mizuno K. Short-term amiodarone treatment attenuates the production of monocyte cytokines and chemokines by C-reactive protein and improves cardiac function in patients with idiopathic dilated cardiomyopathy and ventricular tachycardia. Circ J 2009;73:639-46. https://doi.org/10.1253/circj.CJ-08-0794
  14. Deal BJ, Keane JF, Gillette PC, Garson A Jr. Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol 1985;5:130-5. https://doi.org/10.1016/S0735-1097(85)80095-4

Cited by

  1. Pharmacologic therapy with flecainide for asymptomatic Wolff-Parkinson-White syndrome in an infant with severe left ventricular dyssynchrony vol.28, pp.7, 2013, https://doi.org/10.1017/s1047951118000252
  2. Improvement in Dyssynchrony with Pharmacological Ablation of Right-Sided Accessory Pathway-Induced Cardiomyopathy in Infants vol.60, pp.5, 2013, https://doi.org/10.1536/ihj.18-723
  3. Flecainide improves cardiac synchronization in an early infant with Wolff–Parkinson–White syndrome with left ventricular dyssynchrony vol.22, pp.1, 2013, https://doi.org/10.1016/j.jccase.2020.03.004
  4. Association between severity of cardiac dysfunction caused by ventricular pre‐excitation‐led dyssynchrony and cardiac function recovery after ablation in children vol.31, pp.7, 2013, https://doi.org/10.1111/jce.14521
  5. Pre-excitation cardiac problems in children: recognition and treatment vol.179, pp.8, 2013, https://doi.org/10.1007/s00431-020-03701-9
  6. Perspective of preexcitation induced cardiomyopathy; early septal contraction, and subsequent rebound stretch vol.79, pp.1, 2013, https://doi.org/10.1016/j.jjcc.2021.08.017