Improvement in Dyssynchrony with Pharmacological Ablation of Right-Sided Accessory Pathway-Induced Cardiomyopathy in...

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Pharmacology

Background:

• Right-sided accessory pathways in Wolff-Parkinson-White (WPW) syndrome are associated with cardiac dyssynchrony and dilated cardiomyopathy.
• This cardiac dysfunction can manifest with a characteristic septal shape, independent of supraventricular tachycardia episodes.

Observation:

• Two infants, aged 13 and 5 months, presented with dilated cardiomyopathy attributed to right-sided accessory pathways.
• These infants experienced abnormal aneurysmal dilation of the basal interventricular septum and reduced ejection fraction.

Findings:

• Flecainide administration resulted in successful treatment of the dilated cardiomyopathy in both infants.
• Post-treatment, the abnormal septal dilation significantly improved, nearing normalization.
• Ejection fraction recovered following flecainide treatment.

Implications:

• Flecainide represents a novel and potentially crucial therapeutic option for managing right-sided accessory pathway-induced dilated cardiomyopathy in infants.
• This pharmacological approach may obviate the need for invasive catheter ablation procedures during early infancy.
• Early intervention with flecainide could prevent long-term cardiac complications associated with untreated WPW syndrome-related cardiomyopathy.