EAPC Quiz: Dilated cardiomyopathy and recurrent sustained ventricular tachycardia

Question Title

* 1. What could be the cause of heart failure?

dilated cariomyopathy

myocarditis

ischaemic heart disease

arrhythmogenic ventricular dysplasia

Question Title

* 2. How should the patient be treated?

Ivabradine

Anticoagulants

Verapamil

Amiodarone

Radiofrequency ablation

After 6 months:
-LVEF decreased to 18%
-ventricular arrhythmias (VA) developed
-permanent AFib diagnosed.
-Chronic heart failure (CHF) II functional class -> III functional class (NYHA)
-Recurrent paroxysmal attacks of sustained ventricular tachycardia (VT) had been transformed into ventricular fibrillation (VFib).

Question Title

* 3. How could the patient be managed?

ICD/CRT-D implantation

Mechanical circulatory support

Discontinuation of Amiodarone

Heart transplantation

Electro-impulse therapy

Sotahexal

After a few months the patient started to cope with severe ventricular arrhythmias (VA) with frequent ICD shocks. LVEF was 13-18%. CHF progressed to advanced with NYHA class IV, episodes of cardiac asthma appeared. Recurrent VT, VFib and cardiac arrest episodes became more frequent and were shocked by ICD. Syncope were present. On transthoracic echocardiogram (TTE) left atrial appendage thrombus was found.

Question Title

* 4. How to manage the patient?

VT catheter ablation

Heart transplantation

Coronary artery stent implantation

Renal sympathetic denervation

The patient was undergoing renal sympathetic denervation. After the surgery, no development of arrhythmias happened. After a few months, the patient underwent heart transplantation. According to results of a native heart biopsy, the recipient had dilated cardiomyopathy (post-inflammatory), could not exclude the transferred myocarditis. During early-term follow-up episodes of atrial fibrillation maintained but with no recurrence later. After more than a year after transplantation follow-up no arrhythmias occurred.