title: Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway.
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.
authors.affiliation: Division of Cardiovascular Medicine, Section of Electrophysiology, University of Louisville, Louisville, KY.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gopinathannair
authors.forename: Dwayne N
authors.initials: DN
authors.lastname: Campbell
authors.forename: Alexander
authors.initials: A
authors.lastname: Mazur
keywords: Left ventricular dysfunction; accessory pathway; complete AV block; dyssynchrony; right free wall