arrhythmia

Thank you for this Cleveland forum. I'm in my early 40's, had surg. for VSD as a child and am 2 years post RVOT ablation; currently on a medication I cannot really tolerate. At time of ablation VT then VF was induced and I was shocked. No ICD implanted at that time. Pretty stable since (less ectopics) although will soon be off current arrhy. medication and have tried most other medications: calcium channel blockers, sodium and beta blockers.
Am I at risk for developing VF or sudden death; and if so, what are my options at this point? What would make a doctor decide whether or not to implant an ICD? Is there danger when off medication and should I quickly find another arrhy. medication and what other new ones are available? Not seeing an EP specialist at this time-followed by my regular cardiologist.
Thanks.
Sal

[CCF-M.D.-RCJ]

Sal,

I'll assume that you had ablation of a Repetitive Monomorphic Ventricular Tachycardia (RMVT) located in the RVOT.

Assuming that a person has an otherwise structurally normal heart, and that this fact has been verified by coronary angiography, pateints with RMVT appear to be at low risk for sudden cardiac death.  The risk, in fact, is basically the same as that of the general population.

I am not aware of what impact a history of repaired VSD would be on the prognosis, however.

I would consider seeing an EP specialist at a large institution to help decide on whether or not an ICD is needed.  I think most EPs would not place an ICD in someone with a history of repaired VSD, normal coronary arteries, normal left ventricular function, and history of RVOT ablation.

The first line medications for RVOT VT include beta and calcium channel blockers, followed by amiodarone and sotalol.  I am not aware of new therapies besides these.

Hope that helps.

[debra21784]

Sorry to hear of your difficulities.Remember I am not a physician here ,it seems prudent to me to have an EP cardiologist as part of the team taking care of you.Have you made this suggestion to your doc? Most large academic medical centers have a arrythmia or EP department.I certainly would talk it over with your current cardiologist about getting another team member on board.Good Luck

[mrsally]

Thanks for your reply. In fact, I had polymorphic beats. The ablation was for that and ectopics from scar tissue. I also have RBBB. Very active otherwise healthy person although get SOB easily. I will go to see an EP specialist.