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

Yukio Hiroi; Katsuhito Fujiu; Shuhei Komatsu; Makoto Sonoda; Yasunari Sakomura; Yasushi Imai; Yumi Oishi; Fumitaka Nakamura; Kohsuke Ajiki; Noriyuki Hayami; Yuji Murakawa; Minoru Ohno; Yasunobu Hirata; Kuni Ohtomo; Ryozo Nagai

doi:10.1536/jhj.45.169

Case Reports

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

Yukio Hiroi, Katsuhito Fujiu, Shuhei Komatsu, Makoto Sonoda, Yasunari Sakomura, Yasushi Imai, Yumi Oishi, Fumitaka Nakamura, Kohsuke Ajiki, Noriyuki Hayami, Yuji Murakawa, Minoru Ohno, Yasunobu Hirata, Kuni Ohtomo, Ryozo Nagai

Author information

Yukio Hiroi
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Katsuhito Fujiu
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Shuhei Komatsu
Department of Radiology, University of Tokyo Graduate School of Medicine
Makoto Sonoda
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Yasunari Sakomura
Department of Cardiology, Heart Institute of Japan, Tokyo Women's University
Yasushi Imai
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Yumi Oishi
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Fumitaka Nakamura
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Kohsuke Ajiki
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Noriyuki Hayami
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Yuji Murakawa
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Minoru Ohno
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Yasunobu Hirata
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Kuni Ohtomo
Department of Radiology, University of Tokyo Graduate School of Medicine
Ryozo Nagai
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine

Keywords: Arrhythmogenic right ventriclular cardiomyopathy, Carvedilol, CT

JOURNAL FREE ACCESS

2004 Volume 45 Issue 1 Pages 169-177

DOI https://doi.org/10.1536/jhj.45.169

Details

Abstract

An 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.

Corresponding author

Register with J-STAGE for free!