| Summary: | Background. Hypertrophic cardiomyopathy is the
most common genetic cardiac disorder in Algeria,
although syncope is often caused by ventricular
arrhythmias or left outflow tract obstruction, it may
also, be related to complete atrioventricular block; the
latter is rarely reported in the literature, the
diagnosis is not so obvious and should be thoroughly
researched in presence of syncope. We report two
cases of patients with hypertrophic cardiomyopathy
and atrioventricular block revealed by syncope.
Cases’ presentation. We reported two patients who
presented hypertrophic cardiomyopathy, with
recurrent syncope; one patient presented accessory
the pathway which masked the complete atrio
ventricular block and the other patient presented
alternating occurrence of right bundle branch block
and left bundle branch block at the ECG monitoring
over a 48 hours. Echocardiography showed
hypertrophy of left ventricular walls, but no left
ventricular outflow tract gradient was detected.
Extensive fibrosis especially in the septum was
detected by late gadolinium enhancement. The two
patients were implanted with dual-chamber
pacemakers. During follow up, one patient had
developed refractory heart failure and died in 2014.
Conclusions. Accessory pathway may mask complete
atrioventricular block, also alternating bundle branch
block could be the only proof of complete
atrioventricular block. Fibrosis is the principal
the substrate of reentry phenomenon, but septal fibrosis
can also damage the atrioventricular conduction system.
Non-obstructive hypertrophic cardiomyopathy could
be related to fibrosis, and/or asynchrony.
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