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Significance of morphological and electrophysiological left ventricular restoration in idiopathic dilated cardiomyopathy

^a Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara Sakyo, Kyoto 606-8507, Japan
^b Takagi Cardiology Clinic, Kyoto, Japan
^c Toyohashi Heart Center, Toyohashi, Japan

*Corresponding author. Tel.: +81-75-751-3784; fax: +81-75-751-4960.

E-mail address: shimamo{at}kuhp.kyoto-u.ac.jp (T. Shimamoto).

Treatment of non-ischemic dilated cardiomyopathy (NIDCM) remains a challenge. Morphological left ventricular (LV) restoration such as septal anterior ventricular exclusion (SAVE) can be effective in treating NIDCM; however, residual electrophysiological disorders such as atrioventricular and intraventricular conduction disturbances become apparent in the form of atrial fibrillation (AF) and LV dyssynchrony, which deteriorate postoperative LV function. Thus, the combination of morphological and electrophysiological LV restoration may further improve LV function. Here, we report the case of a patient with end-stage NIDCM complicated with AF and LV dyssynchrony, who was successfully treated with the combined use of SAVE, undersized mitral annuloplasty, left atrial (LA) Maze procedure with cryoablation, and postoperative biventricular pacing. This combination treatment was beneficial in restoring the sinus rhythm and LA and LV functions with improved and synergic wall motion by excluding the dyskinetic/akinetic area, downsizing the LV, resolving mitral regurgitation, and optimizing conduction and rhythm abnormalities. Notably, biventricular pacing was shown to be effective in resolving residual dyssynchrony between the septum and lateral wall after SAVE, wherein a firm, non-compliant Dacron patch was sutured to the septum.

Key Words: Cardiomyopathy; Arrhythmia surgery; Left ventricular restoration; Biventricular pacing; Atrial fibrillation