Heart transforming from WPW to healthy rhythm

When a Wobbly Heart Isn't Just a Rhythm Problem: Understanding WPW and Hidden Cardiomyopathy

Jordan Keane in Health & Wellness July 2025 • 4 min read.

"Discover how Wolff-Parkinson-White syndrome can lead to unexpected heart muscle weakness and what can be done about it."

Heart failure (HF) often stems from a complex interplay of factors, with dyssynchrony – poorly coordinated heart contractions – playing a significant role. While often associated with conditions like dilated ventricles or conduction system diseases, dyssynchrony's impact on heart function and a patient's well-being is well-documented.

Cardiac resynchronization therapy (CRT) has emerged as a valuable tool for managing HF symptoms and improving outcomes by addressing electrical conduction abnormalities. However, ineffective heart contractions and subsequent HF can arise from various other underlying causes.

This article delves into a unique case of severe, symptomatic dilated cardiomyopathy resulting from a right anterolateral accessory pathway (AP). Successful ablation of this pathway led to remarkable improvements in heart function and symptom resolution, highlighting the importance of understanding the diverse electromechanical mechanisms contributing to cardiomyopathy.

The Case: Unmasking WPW-Related Cardiomyopathy

Heart transforming from WPW to healthy rhythm

A 24-year-old chef presented with intermittent atypical chest pain and dyspnea. Initial examinations, including social and family history, revealed no significant contributing factors. However, an ECG unveiled a sinus rhythm, a shortened PR interval, and preexcitation patterns with positive delta waves, indicative of Wolff-Parkinson-White (WPW) syndrome.

Despite the absence of reported arrhythmias, a subsequent echocardiogram revealed a concerningly low ejection fraction of 22% and a dilated left ventricle. The septum displayed significant dyskinesis, and the basal inferior wall exhibited akinetic behavior, raising concerns about underlying cardiomyopathy.

Key Findings
Dilated left ventricle with significantly reduced ejection fraction.
Septal dyskinesis and akinetic basal inferior wall.
ECG evidence of WPW syndrome without reported tachyarrhythmias.

Further investigation via cardiac magnetic resonance imaging confirmed abnormal septal motion without delayed myocardial enhancement. Given these findings, the patient was referred to an electrophysiologist for further evaluation and potential intervention.

Unlocking Recovery: Ablation and the Road to a Healthier Heart

Electrophysiological studies pinpointed the earliest ventricular electrogram at the 10 o'clock position of the tricuspid annulus, confirming the presence of a right anterolateral accessory pathway. Radiofrequency ablation successfully eliminated the pathway, restoring normal electrical conduction.

Follow-up assessments three months post-ablation revealed remarkable improvements. The patient reported increased exercise tolerance, and an echocardiogram showed a normalized PR interval and an ejection fraction that had rebounded to 57% with improved left ventricular dimensions and wall motion.

This case underscores the importance of considering WPW syndrome as a potential cause of cardiomyopathy, even in the absence of incessant tachycardia. Early referral to an electrophysiologist for evaluation and potential ablation can lead to significant improvements in cardiac function and overall quality of life.

About this Article -

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Everything You Need To Know

How can Wolff-Parkinson-White (WPW) syndrome, primarily known for causing rapid heartbeats, lead to heart muscle weakness?

Wolff-Parkinson-White (WPW) syndrome is typically associated with rapid heartbeats due to an extra electrical pathway in the heart. However, in rare cases, continuous pre-excitation caused by the accessory pathway can lead to dilated cardiomyopathy, weakening the heart muscle and reducing its ability to pump blood effectively. This situation can occur even without noticeable arrhythmias.

What does it mean when a patient with Wolff-Parkinson-White (WPW) syndrome is diagnosed with dilated cardiomyopathy, and how does it affect the heart?

Dilated cardiomyopathy in the context of Wolff-Parkinson-White (WPW) syndrome means the left ventricle becomes enlarged and weakened. The heart's pumping efficiency, measured by ejection fraction, is significantly reduced. Specific areas, like the septum and basal inferior wall, may exhibit abnormal or absent movement (dyskinesis and akinesis), respectively, impairing overall heart function.

How does radiofrequency ablation help in cases where Wolff-Parkinson-White (WPW) syndrome has led to heart muscle problems?

Radiofrequency ablation targets and eliminates the accessory pathway in Wolff-Parkinson-White (WPW) syndrome. By restoring normal electrical conduction, ablation can reverse the negative effects of continuous pre-excitation on the heart muscle. In cases where WPW has led to dilated cardiomyopathy, successful ablation can lead to significant improvements in heart function and symptom relief, as the heart no longer has to compensate for the abnormal electrical activity.

Is Cardiac Resynchronization Therapy a solution for Cardiomyopathy arising from Wolff-Parkinson-White?

Cardiac resynchronization therapy (CRT) is typically used to improve heart function in heart failure patients by coordinating the contractions of the left and right ventricles using biventricular pacing. It addresses dyssynchrony commonly found with dilated ventricles or conduction system diseases. In the described case involving Wolff-Parkinson-White (WPW) syndrome, radiofrequency ablation targeting the accessory pathway was used instead of CRT to treat heart muscle weakness.

What is an 'accessory pathway' in Wolff-Parkinson-White (WPW) syndrome, and how does its location impact treatment strategies?

An accessory pathway (AP) in Wolff-Parkinson-White (WPW) syndrome is an extra electrical connection between the atria and ventricles, bypassing the normal AV node pathway. In this particular instance, the accessory pathway was located on the right side of the heart (right anterolateral). Ablation of this specific pathway restored normal electrical conduction, allowing the heart to beat more efficiently and reversing the cardiomyopathy caused by the abnormal electrical activity. The exact location of the AP is critical for electrophysiologists to target during ablation.