How to effectively treat ventricular premature contractions?

Question

Hi doctor,

I was diagnosed with ventricular bigeminy one year after experiencing a myocardial infarction (MI). I am describing my cardiac condition and would appreciate your valuable suggestions. My MI occurred exactly one year ago, and treatment started 20 minutes later with Reteplase and other medications. The following day, I underwent an angiogram, which revealed a 99 percent blockage in the right coronary artery (RCA), and a stent was placed.

After six months, I began experiencing ectopic beats at a rate of around 20 per minute. My medications were adjusted to include Bisoprolol, Metoprolol, and Sotalol, but there was no improvement. My cardiologist has advised an electrophysiological (EP) study. What should I do next? Do I need a device?

I am also attaching a brief overview of my cardiac MRI study and Holter report for your reference.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

I have reviewed your reports (attachment removed to protect patient identity). The ventricular premature contractions (VPCs) are most likely due to scarring in the right ventricle (RV). As advised by the cardiologists, I also recommend an electrophysiological (EP) study. If the study is positive and induces ventricular tachycardia (VT), an implantable cardioverter-defibrillator (ICD) may be necessary.

Another option is the ablation of these VPCs. This procedure tends to be more effective in individuals with structurally normal hearts; however, you have left ventricular (LV) dysfunction. Additionally, ablation is suitable if you are experiencing recurrent ICD shocks.

In summary, I would advocate for an ICD if VT is induced.

Thanks and regards.