[Clinical Case of Severe Heart Failure Treatment, Produced due to the Development of Arrhythmogenic Cardiomyopathy in a Patient With Permanent Junctional Reciprocating Tachycardia (Coumels Tachycardia) With Additional Left Lateral Accessory Pathway].

Thirty two years old man had history of atrioventricular re-entry tachycardia (AVRT) with concealed left-lateral accessory pathway (AP), 3-5episodes per year, 30-40 minutes duration without hemodynamic compromise. Two years ago patient underwent ablation of concealed left lateral AP. After that tachycardia became malignant (high-frequent 150 beats-min, incessant (lasting up to 18 h/day), resistant to AAD, and led to development of tachycardia-induced cardiomyopathy (EF was 16%, and 2 episodes of pulmonary oedema). During redo EPS we verified AVRT with conduction via decremental retrograde left lateral AP which corresponded to the criteria of permanent junctional reciprocating tachycardia (PJRT). Ablation effectively ceased the arrhythmia. After 18 months of follow up there are no symptoms of heart failure and recurrence of arrhythmia.
Conclusions: We present a case of effective treatment of severe heart failure in a patient with arhythtmogenic cardiomyopathy due to malignant course of incessant tachycardia AVRT with retrograde decremental conduction via left lateral AP. Ablation of AP eliminated of arrhythmia. After 18 months of follow up patient had signs of left ventricle reverse remodeling and had not heart failure symptoms.