Wobbly and Weak.

Dyssynchrony is a well-established contributor to systolic heart failure (HF) and is often the sequela of a dilated ventricle and underlying degenerative conduction system disease.(1) Dyssynchrony leads to poorly coordinated ventricular contraction, reduced performance of the left ventricle (LV), and progression of a patient's HF symptoms. This adverse electromechanical relationship has led to the adoption of cardiac resynchronization therapy as a valuable tool for treating HF symptoms and improving mortality.(1) Although dyssynchrony in the setting of left bundle branch block or right ventricular pacing is a well-recognized clinical entity, electrically mediated ineffective contraction resulting in HF can occur in other circumstances. Although preexcitation may result in a tachycardia-induced cardiomyopathy because of an incessant tachycardia, preexcitation by its mechanism may induce dyssynchrony that contributes to HF symptoms.(2) We present a case of a patient with severe, symptomatic, dilated cardiomyopathy because of a right anterolateral accessory pathway (AP). Ablation of this pathway resulted in resolution of LV dysfunction and symptoms. This case highlights an important electromechanical mechanism of cardiomyopathy and the integral role of radiofrequency ablation in its management.