Nonspecific Intraventricular Conduction Delay in the ECG as First Sign of a Congenital Left Ventricular Aneurysm

Objectives: A congenital left ventricular aneurysm (LVA) is a rare cardiac malformation characterized by a discrete region of ventricular wall that is thinner than the adjacent myocardial segments, balloons outward, and exhibits either akinesis or dyskinesis. Cardiac mortality is significantly increased in LVA patients.

Methods: Case report.

Result: Here, we report on a 13-year-old girl who was diagnosed of nonspecific intraventricular conduction delay (QRS duration 120 ms) with noninfarct Q waves in the inferior leads in the ECG which was part of the routine cardiac examination before starting psychotropic drug therapy due to panic attacks with school absenteeism. The echocardiographic presumption of an LV aneurysm was confirmed by a computed tomography and a magnetic resonance imaging scan that showed an anomalous inferoseptal interventricular septum with sawtooth-like inward myocardial projections and a 3-cm aneurysm extending from the anterior to the anterolateral LV wall. Holter ECG did not reveal ventricular arrhythmias that could explain the reported panic attacks. We opted for surgical treatment because of the thin aneurysmatic wall which is thought to be associated with a high risk of rupture and because of a moderately reduced systolic LV function, presumably due to chronic overload and intraventricular dyssynchrony. The aneurysm was excised, and the defect of the LV wall was closed with interrupted 3–0 Prolene sutures over Teflon's strips. The postoperative course was uneventful. During follow-up, the systolic LV function improved.

Conclusion: The presented case underlines the importance of a low threshold for electrocardiograms in childhood, since it may indicate relevant cardiac pathologies such as an LV aneurysm. Whether the reported panic attacks related to relevant ventricular arrhythmias still remained unclear.

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Artikel online veröffentlicht:
21. Februar 2021