title: Reversion of left ventricular systolic dysfunction and abnormal stress test: by catheter ablation, in a patient with Wolff-Parkinson-White syndrome from Para-Hisian Kent bundle.
abstract: The diagnosis of Wolff-Parkinson-White syndrome is typically reserved for patients who experience ventricular pre-excitation and symptoms that are related to paroxysmal supraventricular tachycardia, such as chest pain, dyspnea, dizziness, palpitations, or syncope. Herein, we report the case of a 38-year-old woman who presented at our outpatient department because of exercise intolerance. Cardiac auscultation revealed a grade 2/6 pansystolic murmur over the left lower sternal border. Twelve-lead electrocardiography showed sinus rhythm at a rate of 76 beats/min, with a significant delta wave. Transthoracic echocardiography revealed abnormal left ventricular systolic function. The results of a thallium stress test were also abnormal. Coronary artery disease was suspected; however, coronary angiography yielded normal results. Electrophysiologic study revealed a para-Hisian Kent bundle and a dual atrioventricular nodal pathway. After radiofrequency catheter ablation was performed, the patient's left ventricular function improved and her symptoms disappeared. In Wolff-Parkinson-White syndrome, left ventricular systolic dyssynchrony can yield abnormal findings on echocardiography and thallium scanning--even in persons who have no cardiovascular risk factors. Physicians who are armed with this knowledge can avoid performing coronary angiography unnecessarily. Catheter ablation can reverse the dyssynchrony of the ventricle and improve the patient's symptoms.
authors.affiliation: Department of Medicine, Division of Cardiology, Song-Shan Armed Forces General Hospital, Taipei 105, Taiwan, Republic of China.
authors.forename: Chung-Ming
authors.initials: CM
authors.lastname: Tu
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Chu
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Cheng
authors.forename: Shu-Mung
authors.initials: SM
authors.lastname: Cheng
authors.forename: Wei-Shiang
authors.initials: WS
authors.lastname: Lin
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000503:physiopathology*; D000328:Adult; D017115:Catheter Ablation; D004452:Echocardiography; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006326:Heart Auscultation; D006801:Humans; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*