[SCD-FORUM] 104E RE: Case: Male, 29yrs. Dr. Brembilla-Perrot

[SCD Symposium]

Dear Dr Dubner and Dr Schapachnick

I would like to answer to Dr Zhu.


ICD is certainly the best means to prevent SD in this young patient  
with syncopal VT and suspected of ARVD.
But if it not possible it is at least necessary to introduce beta  
blockers in association with propafenone and why not to discuss  
amiodarone with beta blockers.
Sincerely yours
B Brembilla-Perrot


>
>
> Except ICD we will have no other way to help him, right?  I mean if  
> he doesn’t have enough money, then what we can do for him?  He is  
> only 29,
>
> Dr. Zhu
>
>
>
>
>>
>> The patient might be ARVD, and ICD implantation might be required.
>>
>>
>>
>>
>>>
>>> Case: Male, 29yrs
>>>
>>> Illness history: Viral myocarditis was diagnosed based on  
>>> premature ventricular contractions (PVCs) at age 8 after an  
>>> influenza attack. Since then, PVBs never disappeared and right  
>>> ventricle enlargement had been noticed.
>>>
>>> ECG revealed VT lasting 3 minutes at age 19, accompanied with  
>>> faintness. After 2-3 years, no VT reoccurred.
>>>
>>> The second VT episode was recorded at age 21 lasting 2-3 hrs  
>>> accompanied with syncope. Intravenous propafenon worked. Oral  
>>> administration of propafenon could not prevent the patient from  
>>> VT attack.
>>>
>>> RFCA for VT had been delivered twice at age 22~23 by Pro. Yang at  
>>> the first affiliated Hospital of Dalian medical university.  
>>> During RFCA, VT could not be induced and cardiomyopathy was  
>>> diagnosed by endocardiac biopsy.
>>>
>>>
>>> VTs occurred intermediately lasting several seconds to a few  
>>> minutes. VT restored to sinuous rhythm either spontaneously or by  
>>> intravenous propafenon administration. VT usually occurred at  
>>> midnight or early morning. At the following years, Sometimes VT  
>>> occurred quite often during a certain period (for example: twice  
>>> attacks in Winter), and then no occurrence for several months or  
>>> even longer time. The patient enjoys doing exercise. No VT  
>>> attacked during exercise. No restriction to exercise.
>>>
>>> Since 27 yrs old (2004), propafenon has been administrated in the  
>>> doses of 150mg bid or tid. Drug quitted after 1-2 months  
>>> administrations, keeping no VT attack for 0.5-1.5 yrs.
>>> Since last year, the drug cannot be quitted, otherwise VT  
>>> reoccurred. So far, the doses of the drug are 200mg at early  
>>> morning and 150mg at night. Lower dosages may not prevent the VTs.
>>>
>>> Any suggestion about the treatment?
>>>
>>> Zhu <dyeyxnk at yahoo.com.cn>

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