Recently, cases of pharmacological resynchronization for
Wolff-Parkinson-White syndrome (WPWS) in children with left ventricular dyssynchrony (LVD) were reported, but an appropriate pharmacological
therapy has not yet been established. A 3-month-old, previously healthy female patient was referred to our hospital due to
supraventricular tachycardia (SVT). After resolution of the SVT, 12-lead electrocardiography (ECG) showed ventricular pre-excitation. Transthoracic echocardiography showed LVD with no findings of
congenital heart disease or
cardiomyopathy. To prevent SVT recurrence, oral
propranolol administration was started, but the SVT recurred one month later. To prevent further recurrences, oral
flecainide administration was started, as the patient's
body weight was insufficient for
catheter ablation to be performed safely. When the
flecainide dosage was increased to 50 mg/m2/day, the pre-excitation resolved, and the LVD improved. Holter ECG showed that the resolution of pre-excitation depended on the serum concentration of
flecainide. There are only few reports on pharmacological resynchronization in WPWS patients with LVD (LVD-WPWS). The present report is the first to examine the efficacy of
flecainide in patients with recurrent SVT.
Flecainide may be a safe and effective alternative resynchronization
therapy for LVD-WPWS patients, especially for children in whom
catheter ablation cannot be performed safely due to insufficient
body weight. <Learning objective: While cases of pharmacological resynchronization for
Wolff-Parkinson-White syndrome (WPWS) in children with left ventricular dyssynchrony (LVD) have been reported, an appropriate pharmacological
therapy has yet to be established.
Flecainide may be a safe and effective alternative resynchronization
therapy for WPWS with LVD, especially for children in whom
catheter ablation cannot be performed safely due to insufficient
body weight.>.