Carvedilol Therapy Improved Left Ventricular Function in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

SUMMARYAn asymptomatic 35 year-old man was referred to our hospital because of abnormal ECG findings. The ECG showed complete right bundle branch block and left anterior hemiblock. Echocardiography revealed a moderately enlarged right ventricle (RV) and an apical aneurysm. RV wall motion showed diffusely moderate impairment, while the systolic function of the left ventricle (LV) was slightly decreased. The ejection fractions (EF) of the RV and LV were calculated as 28.1% and 41.9% by Simpson's method using multiple cardiac computed tomography (CT) scans. A 24 hour ambulatory ECG showed only 372 single premature ventricular contractions (PVC). Cardiac catheterizaion revealed that the RV was enlarged with prominent trabeculation and decreased motion. In an electrophysiologic study, neither electrical stimulation of the RV nor electrical stimulation plus isoproterenol infusion could induce ventricular tachycardia. Pathological examination of a biopsy from the interventricular septum of the RV revealed fibrofatty change in the myocardium. Based on these results, we made a diagnosis of arrhythmogenic right ventriclular cardiomyopathy (ARVC) and administered 5 mg of carvedilol. Sixty days after the initiation of carvedilol therapy, we performed repeat cardiac CT. The EF of the LV was markedly improved from 41.9% to 62.0%, although the EF of the RV was not changed. The number of PVCs showed no change. This case suggests that carvedilol is not only useful for controlling arrhythmia but also for improving left ventriclular function in some patients with ARVC. Sympathetic overactivity is reported to cause sudden death, so carvedilol may be a first-line drug for some patients with ARVC. (Jpn Heart J 2004; 45: 169-177)

Arrhythmogenic right ventricular cardiomyopathy/dysplasia: An update

“…This approach applies particularly to probands. Uncertainty remains as to whether patients with probable ARVC/D and/or asymptomatic family members of probands with ARVC/D who meet criteria for ARVC/D should also undergo ICD implantation [ 43 ].…”

Arrhythmogenic right-ventricular dysplasia/cardiomyopathy

“…Symptomatic ventricular arrhythmias are treated initially with beta-blocker therapy [28]. If this is inadequate to control a patient's symptoms or to prevent recurrent ventricular tachycardia then membrane-active antiarrhythmic agents such as sotalol and, if necessary, amiadarone are considered.…”

Arrhythmogenic right ventricular dysplasia/ cardiomyopathy

“…• Symptomatic ventricular arrhythmias are treated initially with ␤-blocker therapy [35,36]. If this is inadequate to control a patient's symptoms or to prevent recurrent VT, membrane-active antiarrhythmic agents, such as sotalol and if necessary amiodarone, are considered [37].…”