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Tachycardia-induced cardiomyopathy in a patient with left-sided accessory pathway and left bundle branch block: A

Ioan Alexandru Minciuna1, Mihai Puiu, Gabriel Cismaru

  • 15th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Hatieganu" Univerity of Medicine and Pharmacy Cluj-Napoca, Romania.

Medicine
|August 9, 2019
PubMed

Insights

Tachycardia-induced cardiomyopathy (TIC) from atrioventricular reentrant tachycardia (AVRT) with left bundle branch block (LBBB) can be effectively treated with catheter ablation, restoring normal heart function. This intervention resolves heart failure symptoms and improves left ventricular ejection fraction.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Research

Background:

  • Tachycardia-induced cardiomyopathy (TIC) results from prolonged elevated heart rates, causing reversible left ventricular dysfunction.
  • Atrioventricular reentrant tachycardia (AVRT) is a frequent cause of TIC, often requiring catheter ablation for incessant forms.
  • Left bundle branch block (LBBB) in AVRT complicates diagnosis and localization of accessory pathways (APs).

Observation:

  • A 60-year-old woman presented with incessant palpitations and shortness of breath due to LBBB tachycardia causing hemodynamic instability.
  • Echocardiography revealed global hypokinesia and a reduced left ventricular ejection fraction (LVEF) of 25%, leading to suspicion of TIC.

Findings:

  • Electrophysiological study identified a left lateral accessory pathway.
  • Successful catheter ablation of the AP at the lateral mitral ring was performed.
  • Post-ablation, the patient's heart failure signs resolved, and LVEF normalized to 55% within one week.

Implications:

  • AVRT with intrinsic LBBB is a rare but significant cause of TIC.
  • Catheter ablation is the preferred treatment for AVRT-induced cardiomyopathy in patients with LBBB.
  • Surface ECG analysis of QRS complex variations may aid in early diagnosis of ipsilateral APs in these complex cases.
Abstract

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