[SCD-FORUM] 45C RE: A children with LQTS. Dr. Cuilan Li

[SCD Symposium]

Dear Dr. Haghjoo:


It’s a true challenge for treating such young LQTS patient (5-y-o),  
especially, it is difficuilt to increase the dosage of Betablocker  
while patient has low heart rate.  Based our experience ,my  
suggestion is:
1.     To change betablocker from propranolol to Metoprolol extended  
action tablet or nadolol (depending on what you can get in your  
country);

2.     If the patient continues to have syncope episode during  
betablocker administration, recommend her to receive the left  
sympathetic denervation surgery.  We had undergo such surgery for a 6  
y-o boy 5 years ago and for a 7-y-o girl last Sept. in Peking  
University People’s Hospital, China.  It’s not unconquerable for  
surgery though it’s more difficult than that for adult patients. Dr.  
Schwartz’s group has more experiences to deal with patients who need  
surgery.

3.     When her body size is large enough, ICD may be considered  
depending on her symptom at that time.

It’s a wonderful experience to exchange opinions with experts from  
world wide, and thanks to the organizers, thanks to the participants  
from so many countries!

Cuilan Li, Ph. D
Department of Cardiology,
Peking University People’s Hosp.,
Beijing 100044, China
Tel: 86-10-68314422 Ext. 5940
licuilan at gmail.com

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee


>
> Dear Dr. Dubner,
>
> Thank you and your colleagues for this nice online symposium.
> Recently, a
> 5-year-old children with no evidence of structural heart disease
> referred to
> our center for evaluation of syncope. He also had history of  
> congenital
> deafness. One of the episodes of syncope occurred 48-hrs after
> betablocker
> withdrawal and second episodes on 10 mg propranolol tid. Surface ECG
> revealed a QTc=600 ms and heart rate of 55 bpm. We think that onset in
> childhood, congenital deafness and QTc=600 would place this patient at
> higher risk for cardiac events and therefore a candidate for ICD
> implantation. However, small body size and future risk of  
> inappropriate
> therapy with its devastating consequences are unfavorable aspects  
> of ICD
> implantation. Our limitimg factors for increase in dose of
> betablocker is
> low baseline hear rate. What is recommendation of scientific
> committee of
> SCD symposium regarding our patient?
>
> Thank you in advance for your recommendation.
>
> Regards,
>
> Majid Haghjoo,MD
> Department of Pacemaker and Electrophysiology
> Rajaie Cardiovascular Medical and Research Center
> Tel: +98 21 2392 2931
> Fax:+98 21 2204 8174
> Tehran, Iran

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