<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Dear Dr Zhu</SPAN></FONT></DIV><P style="margin: 0.0px 0.0px 0.0px 0.0px"><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT></P><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Interesting case. In such a case it is important what is the probable site of origin of VT ? Is the VT always of the same morphology ?</SPAN></FONT></DIV><P style="margin: 0.0px 0.0px 0.0px 0.0px"><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT></P><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">If VT originates in the left ventricle it is probably the result of myocarditis</SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">If VT originates in the RV it is probably a case of ARVD or IDCM with preserved cardiac function.</SPAN></FONT></DIV><P style="margin: 0.0px 0.0px 0.0px 0.0px"><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT></P><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Therefore it is also important to have a better description of the clinical expression of myocarditis. How severe it was?</SPAN></FONT></DIV><P style="margin: 0.0px 0.0px 0.0px 0.0px"><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT></P><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">It is also important to know if regular echo showed a decrease in cardiac function.</SPAN></FONT></DIV><P style="margin: 0.0px 0.0px 0.0px 0.0px"><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT></P><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" color="#001974" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Guy Fontaine MD PhD</SPAN></FONT></DIV><BR><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><BR style="font-family: Lucida Grande; font-size: 13px; "></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Edgardo<SPAN class="Apple-converted-space"> </SPAN>Schapachnik</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Steering<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><BR class="khtml-block-placeholder"></DIV></SPAN></DIV><DIV><BLOCKQUOTE type="cite"><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; min-height: 14px; "><BR></DIV> <DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">Case: Male, 29yrs</FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma"> </FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">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.</FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma"> </FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">ECG revealed VT lasting 3 minutes at age 19, accompanied with faintness. After 2-3 years, no VT reoccurred.</FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma"> </FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">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.</FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma"> </FONT><O:P></O:P></SPAN></DIV><P class="MsoNormal" style="tab-stops:0cm"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">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.</FONT><O:P></O:P></SPAN></P><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma"> </FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">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.</FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma"> </FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">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.</FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma">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.</FONT><O:P></O:P></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma"> </FONT><O:P></O:P></SPAN></DIV><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma" size="4"><SPAN class="Apple-style-span" style="font-size: 14px;">Any suggestion about the treatment?</SPAN></FONT></SPAN><DIV><BR class="khtml-block-placeholder"></DIV><DIV><B>Zhu <<A href="mailto:dyeyxnk@yahoo.com.cn">dyeyxnk@yahoo.com.cn</A>></B><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Tahoma" size="4"><SPAN class="Apple-style-span" style="font-size: 14px;"></SPAN></FONT></SPAN></DIV></BLOCKQUOTE></DIV><BR></BODY></HTML>