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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 - Korean Circ J (2013)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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.
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Figure 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.

Mentions: There was significant improvement of LVEF (27% vs. 39%, normal range: 55-65% at his age) and reduction of LVEDD (58 mm vs. 52 mm, normal range 30-38 mm). However, reduction of amiodarone dosage brought the increase of the QRS duration (117 ms vs. 126 ms), with deterioration of the LVEF (Figs. 1A, B and 2). After confirming the effect of preexcitation on left ventricular function, RFCA of the right anterior AP was successfully performed, resulting in LVEF improvement (19% vs. 38%), reduction of LVEDD (58.3 mm vs. 54.6 mm), shortening of QRS duration (126 ms vs. 80 ms) and disappearance of preexcitation (Fig. 1C). Echocardiography also showed disappearance of left ventricle dyssynchrony (Fig. 3). The patient is doing well with gradual improvement of left ventricular function.


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 - Korean Circ J (2013)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569569&req=5

Figure 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.
Mentions: There was significant improvement of LVEF (27% vs. 39%, normal range: 55-65% at his age) and reduction of LVEDD (58 mm vs. 52 mm, normal range 30-38 mm). However, reduction of amiodarone dosage brought the increase of the QRS duration (117 ms vs. 126 ms), with deterioration of the LVEF (Figs. 1A, B and 2). After confirming the effect of preexcitation on left ventricular function, RFCA of the right anterior AP was successfully performed, resulting in LVEF improvement (19% vs. 38%), reduction of LVEDD (58.3 mm vs. 54.6 mm), shortening of QRS duration (126 ms vs. 80 ms) and disappearance of preexcitation (Fig. 1C). Echocardiography also showed disappearance of left ventricle dyssynchrony (Fig. 3). The patient is doing well with gradual improvement of left ventricular function.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

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.

No MeSH data available.


Related in: MedlinePlus