继发于预激综合征和右侧间隔旁道的不同步性左心室心肌病的青少年表现
Teen Presentation of Dyssynchronous Left Ventricular Cardiomyopathy Secondary to Wolff-Parkinson-White Syndrome and Right-Sided Septal Pathway.
作者信息
Shah Pal V, Patel Dhruvil A, Ganigara Madhusudan, Earing Michael G
机构信息
Department of Internal Medicine, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA.
Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
出版信息
JACC Case Rep. 2025 Jul 30;30(21):104400. doi: 10.1016/j.jaccas.2025.104400.
BACKGROUND
Wolff-Parkinson-White (WPW) syndrome is associated with an abnormal accessory conduction pathway leading to ventricular pre-excitation and potential re-entrant tachyarrhythmias.
CASE SUMMARY
A 13-year-old female presents with shortness of breath, cough, and wheezing for 1 day. She was tachycardic with a left bundle branch block. Echocardiographic findings were notable for dyskinetic septal wall motion with a repeat electrocardiogram uncovering pre-excitation pattern consistent with WPW syndrome and an expected right septal or posteroseptal accessory pathway. Tachycardia had self-resolved, and an outpatient radiofrequency ablation (RFA) was scheduled.
DISCUSSION
WPW syndrome with right septal or posteroseptal accessory pathways causes eccentric septal mechanical activation and may provoke left ventricular (LV) dys-synchrony and dysfunction. Successful RFA is associated with normalization of QRS duration, mechanical resynchronization, and improved LV function.
TAKE-HOME MESSAGE: Even in the absence of arrhythmias, our center advocates RFA of right septal or posteroseptal pathways in all patients with significantly decreased LV function.
背景
预激综合征（WPW）与异常附加传导通路相关，可导致心室预激和潜在的折返性快速心律失常。
病例摘要
一名13岁女性因呼吸急促、咳嗽和喘息1天就诊。她心动过速，伴有左束支传导阻滞。超声心动图检查发现室间隔运动障碍，重复心电图显示预激模式，符合WPW综合征，预期为右间隔或后间隔附加通路。心动过速已自行缓解，计划进行门诊射频消融（RFA）。
讨论
伴有右间隔或后间隔附加通路的WPW综合征可导致室间隔机械激活偏心，可能引发左心室（LV）不同步和功能障碍。成功的RFA与QRS波时限正常化、机械再同步化以及左心室功能改善相关。
要点
即使在无心律失常的情况下，我们中心仍主张对所有左心室功能显著下降的患者进行右间隔或后间隔通路的RFA。
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