Key result
Metoprolol resolves post-ablation functional LVOT obstruction and mitral valve systolic anterior motion.
Why the study?
Accessory pathway ablation can occasionally cause systolic anterior motion of the mitral valve leaflet and functional LVOT obstruction, even in patients without hypertrophic cardiomyopathy.
Case Report (n=1)
No
Accessory pathway ablation in WPW syndrome can rarely cause functional LVOT obstruction due to mitral valve SAM, which can be effectively managed with beta-blocker therapy.
Answers are grounded in this paper and cite their sources.
May warrant beta-blocker trial in post-ablation functional LVOT obstruction; leaves open generalizability beyond this single case.
Background Accessory pathway ablation is recommended for patients with symptomatic Wolff–Parkinson–White (WPW) syndrome. Although elimination of the accessory pathway restores normal ventricular activation and improves synchrony, it can occasionally cause systolic anterior motion (SAM) of the mitral valve leaflet, which can lead to functional left ventricular outflow tract (LVOT) obstruction. Case Summary We report a case of a patient admitted with WPW syndrome. After successful posteroseptal accessory pathway ablation, the patient developed exertional chest tightness and syncope. Echocardiography revealed significant SAM of the mitral valve leaflet and an elevated LVOT peak pressure gradient. Cardiac magnetic resonance confirmed a sigmoid-shaped interventricular septum and a small left ventricular cavity. Genetic testing excluded pathogenic mutations in genes associated with hypertrophic cardiomyopathy. Treatment with metoprolol alleviated his symptoms, with no recurrence of syncope. Follow-up echocardiography showed that the SAM of the mitral valve leaflet had been resolved. Conclusion Although SAM of the mitral valve leaflet rarely occurs following accessory ablation, it could induce deleterious consequences. We hypothesized that the coexistence of a sigmoid septum and a small ventricular cavity may increase the risk for functional outflow tract obstruction after accessory pathway ablation.
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Lin et al. (2026) conducted a case report in Wolff-Parkinson-White syndrome with post-ablation systolic anterior motion of the mitral valve (n=1). Metoprolol tartrate was evaluated on Resolution of symptoms and systolic anterior motion of the mitral valve. Metoprolol therapy alleviated symptoms and resolved systolic anterior motion of the mitral valve in a patient with functional LVOT obstruction following accessory pathway ablation.
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