Case Report (n=1)
Radiofrequency ablation of a decrementally conducting accessory A-V pathway at the aortic-mitral junction can successfully treat incessant wide complex tachycardia and acute heart failure in patients with non-ischemic cardiomyopathy.
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May be considered in select refractory cases; leaves open efficacy and generalizability in non-ischemic cardiomyopathy.
A 55-year-old male presented with acute heart failure and incessant wide complex tachycardia resembling an outflow tract ventricular tachycardia. Meticulous analysis of the electrocardiograms established the diagnosis of pre-excitation with prolonged atrio-ventricular (A-V) conduction over a decrementally conducting accessory A-V pathway. "Linking" between the accessory A-V pathway and normal A-V conduction system resulted in sustained maximal pre-excitation as well as periodic transition to normal A-V conduction without appreciable change in heart rate. Successful radiofrequency ablation of this unusual accessory A-V pathway was performed at the aortic-mitral junction. This ameliorated the mechanical dysynchrony, allowed discontinuation of hemodynamic/inotropic support, and resulted in sustained symptomatic improvement.
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Sriram et al. (2021) conducted a case report in Acute heart failure and incessant wide complex tachycardia (n=1). Radiofrequency ablation was evaluated on Amelioration of mechanical dysynchrony, discontinuation of hemodynamic/inotropic support, and sustained symptomatic improvement.
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