Korean Circ J.  2012 Oct;42(10):705-708. 10.4070/kcj.2012.42.10.705.

A Case of Left Ventricular Noncompaction Accompanying Fasciculo-Ventricular Accessory Pathway and Atrial Flutter

• Yim SM
• Jang SW
• Chun HJ
• Kim SJ
• Choi KY
• Kwon BJ
• Kim DB
• Cho EJ
• Lee MY
• Rho TH
• Kim JH

• KMID: 1826469
• DOI: http://doi.org/10.4070/kcj.2012.42.10.705

Abstract

Left ventricular hypertrabeculation/noncompaction (LVHT) is an uncommon type of genetic cardiomyopathy characterized by trabeculations and recesses within the ventricular myocardium. LVHT is associated with diastolic or systolic dysfunction, thromboembolic complications, and arrhythmias, including atrial fibrillation, ventricular arrhythmias, atrioventricular block and Wolff-Parkinson-White syndrome. Herein, we describe a patient who presented with heart failure and wide-complex tachycardia. Echocardiography showed LVHT accompanied with severe mitral regurgitation. The electrophysiologic study revealed a fasciculo-ventricular accessory pathway and atrial flutter (AFL). The AFL was successfully treated with catheter ablation.

Keyword

Isolated noncompaction of the ventricular myocardium; Mitral valve insufficiency; Pre-excitation, Mahaim-type; Atrial flutter

MeSH Terms

Arrhythmias, Cardiac
Atrial Fibrillation
Atrial Flutter
Atrioventricular Block
Cardiomyopathies
Catheter Ablation
Echocardiography
Heart Failure
Humans
Isolated Noncompaction of the Ventricular Myocardium
Mitral Valve Insufficiency
Myocardium
Pre-Excitation, Mahaim-Type
Tachycardia
Wolff-Parkinson-White Syndrome

Figure

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  Fig. 1 The electrocardiography showed sinus rhythm, ventricular pre-excitation, and bizarre ST and T wave abnormality.

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  Fig. 2 The apical view of echocardiography (A) and cardiac magnetic resonance imaging (B) demonstrated deep trabeculations and recesses in the left ventricle.

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  Fig. 3 During the tachycardia, the heart rate was 140 beats per minute and the QRS morphology was similar to the sinus rhythm.

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  Fig. 4 Programmed atrial pacing from right atrium (left) and coronary sinus (right). A duodecapolar catheter was located in the right atrium (Halo). The S1 interval was 700 ms, which was followed by extrastimulus (S2) of 400 ms. Note that S2 caused prolongation of AH interval, but did not affect the HV interval. The HV interval and the degree of pre-excitation remained unchanged from both right atrial and coronary sinus pacing with atrial extrastimuli. CS: coronary sinus, RVa: right ventricular apex, AH: atrium to his, HV: his to ventricle.

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  Fig. 5 Programmed atrial pacing on the proximal coronary sinus area induced typical atrial flutter. CS: coronary sinus, RVa: right ventricular apex.

Reference

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