pac induced cardiomyopathy

[ddavey]

my 22yr old developmentally impaired daughter, diagnosed with dilated cardiomyopathy in march of 05 after a routine cardio visit.  we are now seeing drs at the university of michigan, and with that change they had added digioxin (125mcg 1x day) to her regimen of coreg (50mgs), vasotec, and inspra.  it was discussed during her initial visit that the dcm may be caused by very frequent pac's (48hr holter had shown 30,762 pac's with 177 svt's with runs as long as 7 complexes)  after adding digoxin the amount had decreased to 20,484. she underwent an unsuccessful ablation in july.  the ep was concerned during the procedure that she had a sinus of Valsalva anuerysm, but after TEE it was shown as the same 2.0 cm diameter mass that originates at a 4mm defect at the base of anterior mitral leaflet and protrudes into the left atrium.  she was born with this mass.  for this reason they were unable to ablate on the left, and we now know that all pac's are coming from the left.  her pac's on latest 48hr holter done in august had shown an increase in pac's, now back up 27,363 and digoxin has been increased by adding an additonal125mcg four days a week.  after months of not complaining of lightheaded and dizziness, she is having these symptoms again.    my question is what would the procedure be to remove this mitral-aortic junction mass, as i believe that this mass may be causing the pac's which may be causing the dcm.  there is no blood flow within this mass, and there is no shunt through it or flow into the left atrium.   her ef is stable at 42%  i do understand that it is always best to treat using least invasive procedures, but we know that everything is coming from the left chamber.  or is there a way to ablate on the left without having to go near this anueyrsmal bulge?  thank you  dawn davey

[Douglas Bogart, MD]

The University of Michigan has an excellent cardiology department(electrophysiology section) and I would rely on their opinion.  The problem your daughter has if very unusual  and I doubt anyone will be able to give you a definitive answer.