[SCD-FORUM] 23E RE: A female with burned-out phase of HCM? Dr. Dubner

[SCD Symposium]

Dear Hormoz Alizadeh
If your patient has complete AV block with wide ventricular escape,  
surely she needs electrical stimulation. If there is atrial activity,  
a dual chamber is indicated.
You do not mention any risk factor to think about an ICD, unless you  
assume this is a cardiomyopathy with severe LV and RV dysfunction,  
and on the other hand, to indicate a CRT device it should be  
interesting to know if she has LBBB, if the systolic dysfunction you  
mention implies ventricular dyssynchrony, or if you can perform  
tissue Doppler or any other diagnostic method that shows dysynchrony.
If there is no dyssynchrony, I should go on with a DDDR pacemaker or  
think about a dual chamber ICD in case you confirm a cardiomyopathy.
Best regards,
Sergio Dubner

>
> Dear Dr Dubner
>
>   thank you for this excellent  educational site
>
>   A 38 year old femal referred to our center with new onset dyspnea  
> from a few month ago. She had family history of sudden cardia  
> death. She had CHB with wide ventricular escape rhythm.  
> TT.echocardiography revealed sever LV and RV systolic dysfunction,  
> asymetric septal hyperthrophy, pulmonary hypertention  
> (PAP=65-70mmhg) and without LVOT gradient.patient,s dyspnea  
> improved with low dose diuretics , ACE inhibitor and TPM implantation.
>   Do you recommend DDD pacemaker for this patient?
>   or
>   Do you recommend  ICD-DR or ICD-CRT?
>
>   what is your opinion about clinical course of her disease?
>
>   does she need further workup before device implantation?
>
>   sincerely yours
>
>   Hormoz Alizadeh MD
>   Department of Pacemaker and Electrophysiology
> Rajaie Cardiovascular Medical and Research Center
> Tehran, Iran
>
>



--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee




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