Ventricular Pre-excitation Causing Left Ventricular Dysfunction Partially Reverted After Ablation of the Accessory Pathway


  • João Paulo Chaves de Melo
  • Maria Licia Ribeiro Cury Pavão
  • Elerson Arfelli
  • Marcelo Garcia Leal
  • José Antonio Marin-Neto
  • Andre Schmidt


Ventricular dysfunction, Wolff-Parkinson-White syndrome, Catheter ablation


Ventricular pre-excitation is one of the rarest causes of cardiomyopathy induced or mediated by arrhythmia. Right accessory pathways, specifically with left bundle branch block pattern, can cause ventricular dysfunction, since abnormal ventricular activation resulting from anterograde atrioventricular conduction can cause atrioventricular, interventricular, and intraventricular dyssynchrony, with asynchronous contraction of the ventricular wall and mitral regurgitation. An asymptomatic patient, with ventricular pre-excitation with left bundle branch block and moderate ventricular dysfunction at echocardiography, was described. The electrophysiological study demonstrated an accessory route of anterior location and with an anterograde refractory period of 600 ms, successfully performing radiofrequency ablation and substantial improvement of ventricular function.


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Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, et al. PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern: Developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm. 2012;9:1006-24. https://doi. org/10.1016/j.hrthm.2012.03.050

Kohli U, Pumphrey KL, Ahmed A, Das S. Pre-excitation induced ventricular dysfunction and successful berlin heart explantation after accessory pathway ablation. J Electrocardiol. 2018;51(6):1067-70. jelectrocard.2018.09.008

Shan Q, Jin Y, Cao K. Reversible left ventricular dyssynchrony and dysfunction resulting from right ventricular preexcitation. EP Europace. 2007;9(8):697-701. https://doi. org/10.1093/europace/eum138

Bradley DJ, Bradley EA, Baughman KL, Berger RD, Calkins H, Goodman SN, et al. Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA. 2003;289(6):730-40.

Blanc J, Fatemi M, Bertault V, Baraket F, Etienne Y. Evaluation of left bundle branch block as a reversible cause of nonischemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony- induced cardiomyopathy. EP Europace. 2005;7(6):604-10.

William TA, David LH. Cardiac resynchronization therapy for heart failure. Circulation. 2003;108(21):2596-603. https://

William TA, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845-53. NEJMoa013168

Tops LF, Schalij MJ, Holman ER, Van Erven L, Van Der Wall EE, Bax JJ. Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am Coll Cardiol. 2006;48(8):1642-8.

Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M, et al. Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. J Am Coll Cardiol. 2005;45(8):1259-1265.

Tomaske M, Janousek J, Razek V, Gebauer RA, Tomek V, Hindricks G, et al. Adverse effects of Wolff-Parkinson-White syndrome with right septal or posteroseptal accessory pathways on cardiac function. EP Europace. 2008;10(2):181-189.

Guo B, Dai C, Li Q, Li W, Han L. Hazards of ventricular pre-excitation to left ventricular systolic function and ventricular wall motion in children: analysis of 25 cases. Cardiol Young. 2019;29(3):380-388.



How to Cite

Melo, J. P. C. de ., Pavão, M. L. R. C. ., Arfelli, E. ., Leal, M. G. ., Marin-Neto, J. A., & Schmidt, A. . (2020). Ventricular Pre-excitation Causing Left Ventricular Dysfunction Partially Reverted After Ablation of the Accessory Pathway. JOURNAL OF CARDIAC ARRHYTHMIAS, 32(3), 163–166. Retrieved from



Clinical Arrythmia