Teen presentation of dyssynchronous left ventricular cardiomyopathy secondary to Wolff-Parkinson-White syndrome and right-sided septal pathway

Authors

• Pal V. Shah, Department of Internal Medicine, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA. Electronic address: [email protected].
• Dhruvil A. Patel, Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
• Madhusudan Ganigara, Advocate Health - MidwestFollow
• Michael G. Earing, Advocate Health - MidwestFollow

Recommended Citation

Shah PV, Patel DA, Ganigara M, Earing MG. Teen Presentation of Dyssynchronous Left Ventricular Cardiomyopathy Secondary to Wolff-Parkinson-White Syndrome and Right-Sided Septal Pathway. JACC Case Rep. 2025;30(21):104400. doi:10.1016/j.jaccas.2025.104400

Abstract

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.

Type

Article

PubMed ID

40750145