Effects of accessory pathway catheter ablation on left ventricular function in patients with dyssynchrony-induced cardiomyopathy associated with pre-excitation syndrome

Abstract

Aim. To evaluate the effect of radiofrequency ablation (RFA) of accessory pathways on left ventricle (LV) function in patients with Wolff-Parkinson-White (WPW) syndrome and preexitation-induced dyssynchrony cardiomyopathy.Methods. The study included 22 patients with registered preexitation on the ECG and signs of dyssynchronous cardiomyopathy according to echocardiography (Echo): asynchronous movement of interventricular septum, ejection fraction (EF) decrease and/or global longitudinal strain of the left ventricle (GLS LV), heart chamber increase. The average age of patients at the time of RFA of the accessory pathways - 11 years [8;14].Results. A regular normalization of the QRS complex width was observed after RFA (p = 0.0002). To assess reverse LV remodeling, all patients underwent Echo on day 3 after RFA. In patients with an initially reduced LVEF, its increase was noted. In patients with initial dilatation and an increase in LV volume, normalization of these indicators was noted. However, dynamics of LVEF and its volume was not statistically significant in the early postoperative period. According to Speckle-tracking Echo during medical check-up, complete normalization of longitudinal deformation was observed in 13 patients (59%), this indicator improvement - in 7 patients (31.8%). The average GLS LV before RFA was -17.25 [-16.4; -19], after RFA - -21.5 [-19; -24] (p = 0.0001).Conclusion. Reverse remodeling and restoration of LV function after RFA of accessory pathways indicates a cause- and-effect relationship between the accessory pathways functioning and dyssynchronous cardiomyopathy development. Therefore, patients with signs of preexitation-induced dyssynchronous cardiomyopathy are indicated for RFA of accessory pathways, regardless of age and tachycardia paroxysms.