Teen Presentation of Dyssynchronous Left Ventricular Cardiomyopathy Secondary to Wolff-Parkinson-White Syndrome and Right-Sided Septal Pathway.

BACKGROUND

Wolff-Parkinson-White (WPW) syndrome is associated with an abnormal accessory conduction pathway leading to ventricular pre-excitation and potential re-entrant tachyarrhythmias.

CASE SUMMARY: A 13-year-old female presents with shortness of breath, cough, and wheezing for 1 day. She was tachycardic with a left bundle branch block. Echocardiographic findings were notable for dyskinetic septal wall motion with a repeat electrocardiogram uncovering pre-excitation pattern consistent with WPW syndrome and an expected right septal or posteroseptal accessory pathway. Tachycardia had self-resolved, and an outpatient radiofrequency ablation (RFA) was scheduled.

DISCUSSION: WPW syndrome with right septal or posteroseptal accessory pathways causes eccentric septal mechanical activation and may provoke left ventricular (LV) dys-synchrony and dysfunction. Successful RFA is associated with normalization of QRS duration, mechanical resynchronization, and improved LV function.

TAKE-HOME MESSAGE: Even in the absence of arrhythmias, our center advocates RFA of right septal or posteroseptal pathways in all patients with significantly decreased LV function.