Ventricular tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy: How to Manage?

Abstract

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a condition characterized by fibrofatty replacement of the RV myocardium due to genetic abnormality. Structural changes may be absent or minor in the early stages of the disease and be localized in a specific region of the RV. Clinically it appears as RV electrical instability. To reduce the risk of arrhythmic events or sudden cardiac death, device therapy and pharmacotherapy may be recommended. In this paper, we describe a case of a female with ARVC and a brief discussion based on a literature review. The patient presented with chest discomfort accompanied by palpitation. An electrocardiogram (ECG) showed ventricular tachycardia of RV apex origin, and convert to symmetric inverted T-waves and probable epsilon waves in the right precordial leads, mimicking a pseudo-right bundle branch block (RBBB) pattern following electrical cardioversion. The parasternal short-axis view of echocardiography shows severe right ventricular dilatation. Subsequent workup using CMR was planned but the patient refused. We diagnosed this patient with ventricular tachycardia on a background of suspicious arrhythmogenic right ventricular cardiomyopathy. We were able to provide accurate diagnosis and treatment, avoiding potentially fatal consequences. As a result, it is critical to recognize potential ARVC ECG findings and to know when to pursue further research and implement therapies.

Keywords

• t wave inversion; epsilon waves; monomorphic ventricular tachycardia; arrhythmogenic right ventricular cardiomyopathy; implantable cardioverter defibrillator