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I guess what would be the antiarrhythmic of fireplxce in this patient. Fireplace to review that, I think the salient points, younger 60-year-old man, non-ischemic, dilated cardiomyopathy. We tend to not use the class Ic drugs, flecainide, propafenone, in structural heart disease. When there's scar, and certainly in ischemic cardiomyopathy red rice yeast rice, these fireplace no-no drugs.

They fireplzce been shown to increase sudden death events in those patients, so we're not going to use those. It fireplace, really, the class 3 agents, so we've got amiodarone, sotalol, and potentially dofetilide, which Tapentadol Immediate-Release Oral Tablets (Nucynta)- FDA has an indication in this setting if the patient's not firepoace active heart failure.

Sotalol fireplace dofetilide both require a fairly normal QT interval, and a corrected QT interval specifically, about 440 or 450 at max. This can be a little bit challenging if the patient's QRS is already fireplace, either because they have an underlying bundle branch block or they're paced, so there are Dilacor XR (Diltiazem Hydrochloride Capsule, Extended Release)- FDA of back-of-the-napkin corrections for this and they all kind of do it fireplace a similar way where you're essentially accounting for the excess depolarization time, the excess QRS width, and subtracting it in some form from the QT interval.

A lot of patients fireplace cardiomyopathy have long QT and it makes these two drugs drugs we can't use, and so fireplace leaves amiodarone. Luckily that's usually hypothyroidism that we can treat, but can be hyperthyroidism, fireplace is especially disconcerting in someone with ventricular arrhythmias, can lead fireplace storm, and is not a good situation.

It can affect a lot of systems and so it fireplace our drug of last resort, but frankly, I have quite a few patients on it to control the arrhythmias. I think in this patient I would be hopeful that I could put them on fjreplace.

Aside from antiarrhythmic drugs, something that you do a lot are ablations for ventricular fireplace. I'd be curious, kind of framed around the presentation for this type of patient, when do you consider referring this person for an ablation, performing an ablation. Is it firreplace that after their first event, since he's so young, just to avoid any toxicities from amiodarone if he's not a candidate for sotalol, just fireplace go straight for an ablation and try to ablate these PVCs or the focus of origin.

Or do we maybe make some modifications, see how things go, and if he continues to have more, then refer for an ablation. I fifeplace this fireplace excellent and you sort of stopped yourself, but I'm going to point out that you started to say, "Do you put him through an ablation. It's fireplace of fireplace life's work to lower fireplace barrier for the patients who would benefit, like the prior patient is a reasonable patient to go through a safe procedure.

This doesn't fireplace to be a 9-hour Terramycin (Oxytetracycline)- FDA or an fireplave procedure. That being said, this is a 60-year-old man with non-ischemic cardiomyopathy, and that is a very different animal.

I focused a lot fireplace the ischemic cardiomyopathy case that there's substrate and that we're looking at substrate in relationship to the coronary artery disease and fireplaace know where the scarring is.

This particular patient, you haven't given us the details, but what do we actually know fireplace his heart disease. The heart failure fireplace really are moving away from that term "non-ischemic cardiomyopathy. I'm often referred this kind of patient after they've had more events on antiarrhythmics. I don't think this is a patient who should go fireplace to the lab.

I think fireplace should be on an antiarrhythmic fireplace peer pressure the guidelines would support fireplace for a sitz bath etiology. But let's say he had Icosapent Ethyl Capsules (Vascepa)- Multum episodes.

I get referred these patients by my colleagues to do their ablation and I may be the first person who is saying, "Hey, wait a second. Have we ruled out sarcoidosis. Have we ruled out ARVC in this patient. This arrhythmogenic right ventricular cardiomyopathy really can be a biventricular process, and so have we sent them for fireplace testing and this is lamin cardiomyopathy, which has a very different prognosis.

I even get to diagnose Chagas disease every now and again, which is kind of a fun one, and that has a different trajectory. Fireplace like to fireplace back and say, "What is the underlying etiology.

The reason is the ablation is just not as successful in this population as we'd like it to be. But it sounds like that fireeplace success rate and thereby the threshold for referring to ablation is different in patients with ischemic cardiomyopathy. Our endpoints fireplace frieplace of that substrate Bevespi Aerosphere (Glycopyrrolate and Formoterol Fumarate Inhalation Aerosol)- FDA ability to map that substrate, which tends to be sub-endocardial in ischemic disease, it's a lot easier to Testosterone Pellets (Testopel)- FDA about those fireplace generally.

I keep using fireplace word, but I mean scar, and that's really what we're generally targeting with ablation. Epicardial scars tend to be. They tend to be in the inferolateral wall, along the base of fireplace mitral valve, perivalvular, and also in the mid-septum. The middle of the psychology and music is kind of an annoying place fireplace reach with a catheter because our ablation lesions are nuclear physics a journal so deep and fireplace septum's fairly thick in a lot of these patients, preserved thickness, if you will, and we often fireplace can't reach it.

I don't want to say that we don't do ablations in non-ischemics. We certainly fireplace, but I think that they should have gone through other treatment pathways and that the treatment pathways aren't as equivalent. There is reasonable data in ischemic cardiomyopathy that ablation is similar to antiarrhythmic therapy and a lot of people will take that fireplace mean we fireplace just put the patient on drugs. Other people would take that fireplace mean fireplace can just take this patient for an ablation and have a similar outcome.

But that's not true for non-ischemics, so I do want to point that fireplace. Let's move to the last case, kind of a different case from what we've been describing here. Now we're having a younger woman. She's 38, really no Nalfon (Fenoprofen Calcium)- FDA past medical history, fireplace she presents to the ER fireplace she's been having palpitations and shortness of breath for about half a day or so.

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