title: Radiofrequency catheter ablation of the accessory pathway adversely affected the left ventricular outflow tract pressure gradient in a patient with hypertrophic obstructive cardiomyopathy.
abstract: Although hypertrophic cardiomyopathy (HCM) with an accessory pathway is encountered in clinical practice, there is little evidence of a coherent strategy for ablation of the accessory pathway in patients with HCM. We present the case of a 61-year-old man who had type B Wolff-Parkinson-White (WPW) syndrome with hypertrophic obstructive cardiomyopathy (HOCM). Due to paroxysmal atrial fibrillation, he underwent radiofrequency catheter ablation of the accessory pathway located in the right postero-lateral wall to prevent secondary symptomatic events. His LV dyssynchrony improved after the procedure, but the degree of the LV outflow tract (LVOT) pressure gradient was increased. To stabilize the LVOT pressure gradient, he needed additional medications. This case shows that patients with HOCM should be carefully evaluated before making a decision concerning ablation of the accessory pathway.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Nakayama
authors.forename: Masao
authors.initials: M
authors.lastname: Takahashi
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hina
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Fujiu
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kojima
authors.forename: Jiro
authors.initials: J
authors.lastname: Ando
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Imai
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D017115:Catheter Ablation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D014694:Ventricular Outflow Obstruction / Q000150:complications*; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications*