Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway |
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Authors: | Rakesh Gopinathannair Dwayne N. Campbell Alexander Mazur |
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Affiliation: | 1. Division of Cardiovascular Medicine, Section of Electrophysiology, University of Louisville, Louisville, KY;2. Division of Cardiovascular Medicine, Section of Electrophysiology, University of Iowa Hospitals, Iowa City, IA |
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Abstract: | A 24-year-old male with Wolff-Parkinson-White syndrome developed systolic cardiomyopathy and severe heart failure following membranous ventricular septal defect repair and tricuspid valve replacement. Following successful catheter ablation of a right anterolateral accessory pathway (AP), complete AV block with junctional escape rhythm was noted. Patient subsequently underwent implantation of a biventricular ICD. Heart failure symptoms significantly improved soon after and left ventricular systolic function normalized 3 months post-procedure. In this case, surgically acquired AV block likely explains development of postoperative cardiomyopathy by facilitating ventricular activation solely via the AP and thereby increasing the degree of ventricular dyssynchrony. |
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Keywords: | Left ventricular dysfunction accessory pathway right free wall complete AV block dyssynchrony |
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