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Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: ARVD- Arrythmogenic right ventricular dysplasia I have been having this problem with an enlarged RV. I have been taking Amiodatone for the last 6 years (as other drugs did not work) and had only 2 episodes of VT during this period . Recently I reported liver enlargement and pain and VT of 120-130 bpm. The doctor feels that amiodarone has become toxic and thus taken me off that drug. After this during hospitalisation I had several episodes of VT in the range of 120- 130 bpm. which had to be cardioverted. I am now on flecainaide 75 mg twice a day plus beta-blockers and warfarin-anti coagulant. As flecainaide it reportedly very dangerous the doctor feels that heart transplant is the only option. This option is very expensive in India and also risky. Is this the only option left. As the doctor feels there would be too many focal points for the VT he has ruled out ablation as well. Could you advise ? considering I am in India
_ Dear Yatish, thank you for your question. You certainly have a difficult situation. I assume that multiple tests were done to confirm the diagnosis of ARVD in your case. Generally, a biopsy of the right ventricle and/or a cardiac MRI is needed for absolute confirmation. Amiodarone can certainly cause liver toxicity so it sounds like you unfortunately will not be able to take it again. Flecainide is usually safe in patients without structural heart disease, but I don't know any data on its use to treat VT associated with ARVD. There are other medications including sotalol and propafenone that may be safer than flecainide, but your physician would have to determine if these medications are appropriate. I think a heart transplant would be an "end of the line" option to consider only if nothing else works. For now, you appear to be a good candidate for an implantable cardiac defibrillator (ICD). An ICD is a device like a pacemaker that continually senses the heart rhythm and can deliver an internal shock to terminate a lethal arrhythmia like VT or ventricular fibrillation. An ICD can easily be implanted without undergoing surgery and is often life-saving in situations like yours. Usually, an ICD is used in combination with antiarrhythmic medications like flecainide. Thus, I think you should speak to your physician about this option. I don't know where you could have an ICD implanted in India, but if you would like to come to Cleveland, I can help to arrange a visit and possibly, an ICD implantation here. I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. Good luck! If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart | |
