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￭ S-311 ￭
Transvenous Implantation of an ICD in a Patient with a prosthetic valve in the tricuspid position
연세대학교 의과대학 세브란스병원
*Yun-Jeong Lee, MD, Jae-Sun Uhm, MD, PhD, Tae-Hoon Kim, MD, Boyoung Joung, MD, PhD, Hui-Nam Pak, MD, PhD, Moon-Hyoung Lee, MD, PhD, Jong-Won Ha, MD, PhD
Abstract Transvenous implantation of implantable cardioverter-defibrillator (ICD) in patients with a prosthetic valve in the tricuspid position is difficult because a defibrillator lead cannot be implanted into the right ventricle through the prosthetic valve. We report a case of transvenous ICD implantation in a patient who had undergone tricuspid valve replacement with mechanical prosthetic valve. A 70-year-old woman with a prosthetic valve in the tri- cuspid position experienced two times of aborted sudden cardiac arrest. Transvenous dual-chamber ICD implantation was successfuly performed by im- planting a defibrillator lead into the middle cardiac vein. Introduction Implantable cardioverter-defibrillator (ICD) is effective for secondary prevention of sudden cardiac death for patients who experienced aborted sudden cardiac death.(1) and as well as for primary prevention of sudden cardiac arrest for patients with heart failure with reduced ejection fraction(2, 3). Recently, the number of ICD implantation cases is rapidly increasing. However, ICD im- plantation is difficult in some patients with complex structural heart disease, including presence of a prosthetic valve in the tricuspid position, Glenn shunt, and Fontan circulation(4). Especially, in patients with tricuspid prosthetic valve a pacing lead or a defibrillation lead cannot be implanted through the prosthetic valve because of prosthetic valve failure and damage to the lead. There are three options for ICD implantation in those patients; epicardial implantation, subcutaneous ICD implantation, and cardiac vein implantation. We report a case of successful transvenous ICD implantation with a defib- rillator lead in the middle cardiac vein in a 70-year-old female with a prosthetic valve in the tricuspid position.
￭ S-312 ￭
Successful catheter ablation of drug-refractory ventricular tachycardia in a patient with ARVC
Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
*Yeon Kyung Lee, Hae Won Jung, Jae-Jin Kwak, Sung Uk Kwon, Joon Hyung Doh, Sung Yun Lee, Won Ro Lee, June Namgung
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease, leading to fibrofatty infiltration of the right ventricular myocardium and electrical instability, resulting in ventricular arrhythmias. Some patients who have episodes of ventricular fibrillation or ventricular tachycardia (VT) require implantable cardioverter defibrillator (ICD). Catheter ablation should be reserved for patients who have recurrent, therapy refractory ven- tricular arrhythmias in spite of antiarrhythmic therapy and/or recurrent frequent ICD shocks. A 50-year-old man with prior diagnosed ARVC was hospi- talized for sustained monomorphic VT and heart failure with pulmonary edema. The ARVC was diagnosed 7 years earlier and underwent implantation of ICD because of recurrent VT (Figure 1). However, recently, VT recurred frequently and VT sustained over one month and was not respond to medi- cal therapy (Figure 2). So he was treated with various antiarrhythmic agents, however the VT recurred and developed tachycardia induced cardiomyopathy. Subsequently, a radiofrequency catheter ablation was performed. After successful catheter ablation, ECG showed normal sinus rhythm and an epsilon wave in precordial rhythm (Figure 3). The patient was discharged without complication. No further VT occurred during a follow-up of 1 month and the patient could pursue an active lifestyle. However, ARVC is progressive cardiomyopathy, so we need to observation constantly using medical therapy. We report a case of ARVC who underwent radiofrequency catheter ablation for drug-refractory VT.
