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Approaching ventricular arrhythmias in a structurally normal heart


 

EXPERT ANALYSIS FROM THE CARDIOVASCULAR CONFERENCE AT SNOWMASS

On occasion, and with careful informed consent, it’s helpful to turn to empiric amiodarone to help sort out if a patient truly has PVC-induced cardiomyopathy.

"No one likes to prescribe amiodarone in a young patient with cardiomyopathy because amiodarone can produce bad things even when used for 3-6 months. But amiodarone is like an eraser for PVCs, and if, once the PVCs are gone, the ventricular function is still bad, then don’t waste time and put the patient at risk for the possibility of complications by doing a complex ablation. On the other hand, if, after giving amiodarone and the PVCs are gone the ventricular function normalizes, that’s very good evidence that ablation is worth the risk," he explained.

The results of catheter ablation of PVC-induced cardiomyopathy are often spectacular. Dr. Asirvatham recounted the story of a young adult patient whose LVEF had dropped to as low as 6%-8%. After ablation, it’s now 65%-plus and the patient is now an active surgical resident.

Dr. Asirvatham reported serving as a consultant to close to a dozen pharmaceutical and medical device companies.

bjancin@frontlinemedcom.com

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