وجود راه فرعی دهلیزی بطنی می‌تواند باعث نارسایی قلبی به‌علت اختلال توالی دپولاریزاسیون قلبی شود: گزارش یک مورد

زمینه و هدف: سندرم وولف-پارکینسون-وایت بیماری ناشایع و شناخته شده می‌باشد که فرد را مستعد آریتمی‌های قلبی می‌کند و گاهی همراهی آن با نارسایی قلبی در فرد مبتلا دیده می‌شود. درمان بیماری ذیل منجر به بهبود نارسایی قلب نیز شده است.معرفی بیمار: مرد 35 ساله با سابقه سندرم ولف-پارکینسون-وایت، دیلاتاسیون و افت کسر دفعی بطن چپ، با حمله فیبریلاسیون دهلیزی با هدایت از مسیر فرعی به اورژانس مراجعه کرد. بیمار تحت درمان الکتروفیزیولوژی و عمل ابلیشن راه فرعی خلفی-جانبی چپ قرار گرفت. به مرور (در بازه زمانی آذر 1401 تا تیر 1402) عملکرد بطن چپ بیمار رو به بهبودی رفت و علایم تنگی نفس فعالیتی بیمار نیز کاهش یافت.نتیجه‌گیری: وجود نارسایی قلبی در بیماران سندرم ولف-پارکینسون-وایت می‌تواند به‌علل مختلف از جمله وجود راه فرعی و عدم تقارن انقباض داخل بطنی ناشی از آن باشد. حذف این راه فرعی منجر به کنترل حملات آریتمیک و بهبود عملکرد سیستولی بطن چپ می‌شود.

the presence of atrioventricular accessory pathway can cause heart failure due to the disorder of cardiac depolarization sequence: a case report

background: wolff-parkinson-white syndrome is a rare but well-known disease that predisposes a person to cardiac arrhythmias. but sometimes this syndrome is accompanied by heart failure in the affected person. several causes have been proposed for this complication including recurrent or incessant tachyarrhythmias that are frequently found in symptomatic (especially children) wolf-parkinson-white syndrome patients causing heart dysfunction and dilation and dilated cardiomyopathy, and also pre-excitation-related dyssynchrony leading to progressive ventricular remodeling and dilation. in this report, a patient is introduced who has improved his heart failure by radio-frequency ablation of free wall type of this syndrome.case presentation: a 35-year-old man who had a history of wolff-parkinson-white syndrome from 8 years ago and suffered from dilatation and reduced left ventricular ejection fraction in recent years was presented with a pre-excited atrial fibrillation attack at the emergency department. the initial surface ecg showed positive delta wave in all precordial leads and negative qrs complexes in interior leads with qrs duration of about 200 ms. he had undergone electrophysiology study and ablation at the left postero-lateral accessory pathway. after ablation of accessory pathway within the months (from november 2022 until june 2023), left ventricular function was gradually improved and the symptoms of the patient’s shortness of breath were also decreased.conclusion: the existence of heart failure in patients with wolff-parkinson-white syndrome can be due to various reasons including the presence of an accessory pathway and the dyssynchrony of intraventricular contraction which is caused by premature excitation of the connected part of the left ventricle by accessory atrioventricular pathway. although in order to rule out the possibility of the incidental association of the accessory pathway with primary dilated cardiomyopathy and to investigate the segmental dyskinesia, it is necessary to perform diagnostic measures such as echocardiography and cardiac computerized tomography and magnetic resonance imaging, ablation of such accessory pathway not only controls arrhythmic attacks but also leads to the improvement of the left ventricular systolic function even in a middle age patient.