[SCD-FORUM] 52E Comments to clinical case Cuilan Li et al. Clinical patient with catecholamine sensitive polymorphic VT. Dr. Makarov

[SCD Symposium]

Dear collegues! I want to add my comments to clinical case thad  
presented Dr. Cuilan Li et al. “Clinical presentation and management  
of a patient with catecholamine sensitive polymorphic ventricular  
tachycardia (CPVT)”. By my mention it is typical clinical and ECG  
pattern for children and young patients with some of kind of  
catecholaminergic VT (CVT) that we described before (Makarov L. et  
al. Short PR interval, high circadian index and bradycardia – pattern  
with high risk of syncope and sudden death in children with  
catecholaminergic ventricular tachycardia. Europ Heart J 2004; 25:  
222, Suppl. Abstract) and during this symposium: bidirectional VT,  
bradycardia, short PR interval, and double tachycardia (VT and SVT).   
Some of this patients also demonstrated of the shortening of the QT  
interval (possibly as result of calcium overload of cardiomyocites).   
I am sure in arrythmogenic origin of syncope in present patient and  
useful of the active anthyarrhythmic therapy for it.   From drugs  
more effective Beta-blockers (1-2 mg/kg) or/and calcium antagonists  
(verapamil), but authors had detected proarrhythmia from verapamil,  
that not typical for our experience.  In the some patients the  
propafenone can be effective. Most of our patients with CVT showed  
improvement in their clinical symptoms: syncope events and  
ventricular tachycardia did not recur. But in a numerous patients  
that tolerant to therapy with recurrent syncope implantation of the  
ICD could be useful. I am not sure in useful of the EPI study for  
this patient, repetitive of Holter, stress test and/or IV infusion of  
isoproterenol more frequently detected typical bidirectional VT.  
Concern authors question   # 3 (The catecholamine concentration in  
blood was normal for this patient. What do we expect of the  
catecholamine concentrations in CPVT patients in general?)- Fisher  
J.et al. (JACC1999; 34 (7): 2015-22) showed normal or lower level of  
plasma catecholapimes in rest in this patients, but parid increasing  
of it during exercise, to compare with normal range.

Dr. Leonid Makarov M.D., Ph.D. professor (Pediatry)

Moscow Institute pediatry and children surgery.

125412 Taldomskaya str.2 , Moscow, Russia.

leo at oss.ru


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee




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