Resolution of severe cardiomyopathy after catheter ablation of an anteroseptal accessory pathway: A case report

In patients with non-sustained tachyarrhythmias, left ventricular (LV) systolic dysfunction is uncommon. The role of catheter ablation (CA) in asymptomatic patients with tachyarrhythmia remains unclear. We report a 20-year-old patient without sustained tachyarrhythmia with a left ventricular ejection fraction of 20% who underwent radiofrequency catheter ablation (RFCA) of anteroseptal accessory pathway. She achieved normalization of left ventricular systolic function noted on echocardiography performed at 4 weeks post-ablation. Our case highlights significant improvement in LV systolic function after catheter ablation of an “asymptomatic” ventricular pre-excitation. Current guidelines do not endorse ablating asymptomatic patients, but careful follow-up with serial echocardiograms might be warranted. Prophylactic ablation of those patients with clear evidence of LV dyssynchrony or wide left bundle branch pattern and persistent pre-excitation is worth further consideration.