Hassan Khaled Nagi
Cairo University, Egypt
Posters & Accepted Abstracts: J Clin Case Rep
M.A. is a 25 year-old male working as a farmer in Upper Egypt. He is not diabetic or hypertensive and has no FH of heart diseases. Since 2009, he was hospitalized for LV failure several times and has been told that he had idiopathic dilated cardiomyopathy. He had dyspnea NYHA classification III. On October 2013, he was admitted in Assiut University Hospital ICU because of dyspnea and rapid palpitation. His HR was 160 BMN, BP 90/60 and heart exam showed displaced LV apex and S3. EKG showed accelerated junctional tachycardia. He has received I.V. Amiodarone infusion, I.V. Digoxin; I.V. Adenosine in different days but only slowed rate to 140 BMN. Also I.V Potassium and Magnesium infusion failed to terminate tachycardia. Echocardiography confirmed dilated cardiomyopathy diagnosis with LVEF 32%. He was discharged on classic anti failure TT. He presented to my clinic few months later with same incessant junctional tachycardia with AV dissociation documented in many ECGs. I decided to try Catheter RF Ablation for this Tachyarrhythmia and it could successfully convert him into sinus Rhythm. He was symptoms free for few weeks but same junctional tachycardia recurred with deterioration of his symptoms. Considering that patient may have had tachycardiomyopathy. I decided to do RF catheter Ablation of AVN to induce complete AVB and implant permanent pacemaker using single chamber VVI PM (Not DDD for financial reason). Patient markedly improved and now after 1 year follow-up, he is back to full activity and Echo showed regression of LV dimensions and EF increased from 32% at time of RF ablation to 55% now. A tachycardiomyopathy should be always considered in patients with Idiopathic dilated cardiomyopathy and heart failure who suffer from chronic or frequently recurring tachyarrhythmia. Control of the heart rate can often result in a significant improvement of the ventricular function and both symptoms and exercise tolerance. This can be achieved by drugs, RF ablation and pacing. The diagnosis of tachycardia-related cardiomyopathy is made when LV systolic function improves to normal or near normal level after rate control in patients with tachyarrhythmia.
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