Case #2
The 33 years old woman (ATS-002), sister of case #1 (ATS-003), was also invited to our hospital for ATS evaluation. She was asymptomatic. Frequent bidirectional VT was noted on ECG (Figure 3A). TTE revealed fair left ventricular systolic function with LVEF at 52%. Metoprolol was administered and gradually increased to 100 mg daily but her VA was not significantly reduced. One hundred mg of Flecainide per day was then added and cardiac monitoring showed ventricular ectopy becoming less frequent without VT (Figure 3B). Four months after treatment combination, 24-hours Holter monitoring showed sinus rhythm with prominent U-wave and occasional ventricular ectopy, and good biventricular systolic function with trivial mitral valve regurgitation was observed by TTE.
Similar to her sister, the patient decided to underwent her pregnancy without medication after extensive discussion with healthcare team. Her pregnancy was uneventful and she delivered her child successfully. VT was noticed during postpartum monitoring, therefore, Flecainide and Metoprolol combination was resumed. Cardiac arrhythmia remained suppressed at 3 months follow-up visit (Figure 3C).