Korean Circ J.  2013 Jan;43(1):57-61. 10.4070/kcj.2013.43.1.57.

Amiodarone and Catheter Ablation as Cardiac Resynchronization Therapy for Children with Dilated Cardiomyopathy and Wolff-Parkinson-White Syndrome

• Kim SH
• Jeong SI
• Huh J
• Kang IS
• Lee HJ

• KMID: 1723003
• DOI: http://doi.org/10.4070/kcj.2013.43.1.57

Abstract

Preexcitation by accessory pathways (APs) is known to cause dyssynchrony of the ventricle, related to ventricular dysfunction. Correction of ventricular dyssynchrony can improve heart failure in cases of dilated cardiomyopathy (DCMP) with preexcitation. Here, we report the first case of a child with DCMP and Wolff-Parkinson-White (WPW) syndrome treated with amiodarone and radiofrequency catheter ablation (RFCA) in Korea. A 7-year-old boy, who suffered from DCMP and WPW syndrome, showed improved left ventricular function and clinical functional class after treatment with amiodarone to eliminate preexcitation. QRS duration and left ventricular ejection fraction (LVEF) were inversely correlated with amiodarone dosage. After confirming the reduction of preexcitation effects in DCMP, successful RFCA of the right anterior AP resulted in LVEF improvement, along with the disappearance of preexcitation. Our findings suggest that ventricular dyssynchrony, caused by preexcitation in DCMP with WPW syndrome, can worsen ventricular function and amiodarone, as well as RFCA, which should be considered as a treatment option, even in young children.

Keyword

Dilated cardiomyopathy; Wolff-Parkinson-White syndrome; Amiodarone; Radiofrequency catheter ablation; Cardiac resynchronization therapy

MeSH Terms

Amiodarone
Cardiac Resynchronization Therapy
Cardiomyopathy, Dilated
Catheter Ablation
Catheters
Child
Heart Failure
Humans
Korea
Stroke Volume
Ventricular Dysfunction
Ventricular Function
Ventricular Function, Left
Wolff-Parkinson-White Syndrome
Amiodarone

Figure

• 

  Fig. 1 ECG with delta wave. ECG showed the change of delta wave before amiodarone (A) and after amiodarone (B). Delta wave disappeared after use of amiodarone. RFCA also showed successful elimination of delta wave (C). ECG: electrocardiography, RFCA: radiofrequency catheter ablation.

• 

  Fig. 2 The effect of amiodarone. Amiodarone shortened the QRS duration (QRSd) and improve the left ventricular function {LV ejection fraction (LVEF)}. According to the reduction of amiodarone dosage, preexcitation reappeared along with LVEF deterioration. Successful radiofrequency catheter ablation (RFCA) of the right anterior accessory pathway showed improvement of LV function.

• 

  Fig. 3 Time to peak longitudinal velocity images. Echocardiography demonstrated the change of time to peak longitudinal velocity images which are compatible with longitudinal dyssynchrony of the left ventricles before RFCA (A) and improved dyssynchrony after RFCA (B). RFCA: radiofrequency catheter ablation.

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