Available online 30 January 2023

Author links open overlay panelAbstract

The present case describes a dilated cardiomyopathy associated with both antidromic and orthodromic atrio-ventricular reentrant tachycardias supported by multiple right accessory pathways. Both right accessory pathways were successfully eliminated by catheter ablation and the patient progressively recovered during the follow up. The following etiologies might be involved: 1) primitive dilated cardiomyopathy (or post-inflammatory); 2) septal dyssinchrony due to ventricular pre-excitation; 3) tachycardiomyopathy.

Introduction

Wolff-Parkinson-White syndrome (WPW) is a congenital disease with an estimated prevalence of 1 in 450 in the general population; the clinical manifestation includes atrioventricular-entry tachycardias sustained by one or more accessory bundles. The present case deals with a young patient with WPW syndrome who revealed an underlying dilated cardiomyopathy of questionable interpretation.

Section snippetsClinical case

A 35 year-old man was admitted to the Emergency Room (ER) of our hospital for palpitations. The electrocardiogram (ECG) showed a wide QRS tachycardia with a pre-excited, left bundle branch block morphology (Fig. 1A). After vagal maneuvers were unsuccessfully performed, intravenous adenosine (6 mg and 12 mg) stopped the tachycardia with immediate restoration of sinus rhythm confirming the hypothesis of an atrioventricular re-entry tachycardia. The ECG in sinus rhythm confirmed ventricular

Discussion

The presence of dilated cardiomyopathy associated with ventricular pre-excitation in young patients always represents a diagnostic challenge. In our case the following hypotheses can be raised.

A primitive dilated cardiomyopathy associated with WPW syndrome with multiple accessory pathways. In this case, differential diagnosis should be done between a post-inflammatory cardiomyopathy (despite no recent infections neither cardiac symptoms) and a genetically-determined dilated cardiomyopathy

Funding

None.

Author statement

SC: conceptualization, data curation, proof review.

FR: supervision, proof review and editing.

MS: review and editing.

CB: review and editing.

LT: supervision, proof review and editing.

BB: conceptualization, investigation, proof review and editing.

AP: supervision, review and editing.

FLR: supervision, data curation, review and editing, validation.

GM: conceptualization, data curation, formal analysis, writing original draft.

Declaration of Competing Interest

No conflicts of interest to be declared.

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