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Atrio-His (James) accessory pathway and infiltration of γδ T cells in the heart with MELAS
  1. Gen Matsuzaki1,
  2. Akifumi Kushiyama2,
  3. Kenta Uto3,4,
  4. Morio Shoda3,
  5. Yoshinori Seko1
  1. 1Division of Cardiovascular Medicine, Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
  2. 2Division of Diabetes, Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
  3. 3Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
  4. 4Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
  1. Correspondence to Yoshinori Seko, sekoyosh-tky{at}

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A 40-year-old female patient, who was found to have diabetes mellitus during her first pregnancy, and then developed difficulty in hearing, was diagnosed as suffering from mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) due to mutation of mitochondrial DNA (A3243G). The patient complained of palpitation and faintness; ECG demonstrated short PQ interval with normal QRS width and significant ST-segment depression in II, III, aVF and V4-6 (figure 1). Echocardiogram and coronary CT angiogram showed normal findings. Then, electrophysiological study and myocardial biopsy were performed.

Figure 1

12-Lead ECG demonstrating short PQ …

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  • Competing interests None.

  • Patient consent Obtained.

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