[ARVD-FORUM] Management of recurrent VT in a 9 month old Dr. Cuesta

[ARVD Symposium]

English - Spanish

Dear Eduardo,
We have a case of ARVD in a small boy, who was admitted with syncope and
later presented incessant VT. We performed the ablation that fortunately,
was successful and afterward we made some international consultations to
solve the symptoms. Finally, we didn't implant an ICD, and we administered a
little Sotalol. Over two years there have been no episodes and the Holter is
normal.
In such small children, the experiences we know with ICD haven't been good,
due to the number of complications. I think that in the light of current
knowledge, this may be the wise management: ablation + sotalol and wait and
see.
We spoke at length with the family to make them aware that the disease goes
on, about the risks and that in the future an ablation will have to be
performed again and/or an ICD will have to be implanted.

Regards,
AC

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Estimado Eduardo:
Tenemos un caso de ARVD en un niño chico que se presentó con síncope y luego
se comportó como TV incesante. Realizamos la ablación que afortunadamente
fue exitosa y posteriormente realizamos consultas internacionales para
resolver la conducta. Finalmente lo dejamos sin implante de DAI y con un
poco de Sotalol. En dos años no ha repetido episodios y el Holter está
limpio.
En niños tan pequeños, las experiencias que conocemos con DAI no han sido
buenas por la cantidad de complicaciones. Creo que a la luz de los
conocimiento actuales ésta puede ser una conducta prudente. Ablación +
Sotalol y "wait and see".
Hablamos extensamente con la familia para que sepan que la enfermedad
continúa, conozcan los riesgos y estén advertidos que en un futuro habrá que
volver a ablacionar y/o poner el DAI.

Saludos: AC

Alejandro N. Cuesta Holgado MD FCCP
I.C.I. Hospital Italiano - tel 005982 4870416
Cairoli 2045 (11600) Montevideo-Uruguay
P tel: 005989 9617427


ARVD Symposium <info at arvd-symposium.org> escribió:
-----Original Message-----
From: arvd-forum-bounces at ishne.org [mailto:arvd-forum-bounces at ishne.org] On
Behalf Of ARVD Symposium
Sent: 03 June, 2005 13:46
To: Subject: [ARVD-FORUM] question Dr. Mesquita de Oliveira

Forum of the First International Symposium on Arrhythmogenic Right
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de Displasia Arritmogénica de Ventrículo Derecho en Internet | Forum do
Primeiro Simpósio Internacional sobre a Displasia Arritmogénica do
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English - Portuguese

Good afternoon! This case is most difficult since the baby has only 9
months. Do you have an ICD available for this age? Would you place it by
thoraco-abdominal via?
If he was responsive to this association (propranolol + propafenone), I
would maintain ! him with this. If he doesn't respond to this association, I
would give him amiodarone + sotalol (that would strengthen the effect by
amiodarone). Anyway, if an ICD was feasible, I would indicate it!!
Warm regards,
Dr Eduardo Mesquita de Oliveira(Cardiologista do Hospital Israelita
Albert Einstein-São Paulo-Brasil)

-------------------------------

Boa tarde! Dificilimo o caso pois tem somente 9 meses.Tem CDI para essa
idade? A colocação é via toracoabdominal?
Se respondeu a essa associação(propranolol+ propafenona) manteria assim.Caso
nao respondesse a essa associação,daria Amiodarona+ sotalol(que
potencializaria o efeito da amiodarona).De qq forma se fosse possivel um CDI
,eu indicaria!! Grande abraço Obrigado
Dr Eduardo Mesquita de Oliveira(Cardiologista do Hospital Israelita
Albert Einstein-São Paulo-Brasil)

Alejandro N. Cuesta Holgado MD FCCP
I.C.I. Hospital Italiano - tel 005982 4870416
Cairoli 2045 (11600) Montevideo-Uruguay
P tel: 005989 9617427