Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2021; 9(16): 4095-4103
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4095
Arrhythmogenic right ventricular cardiomyopathy characterized by recurrent syncope during exercise: A case report
Hao-Yu Wu, Yi-Wei Cao, Tian-Jiao Gao, Jian-Li Fu, Lei Liang
Hao-Yu Wu, Lei Liang, Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
Yi-Wei Cao, Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
Tian-Jiao Gao, Department of Gastroenterology, Xi’an Children’s Hospital, Xi’an 710003, Shaanxi Province, China
Jian-Li Fu, Department of Ultrasonic Diagnosis Center, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Author contributions: Wu HY and Cao YW drafted the manuscript; Wu HY and Liang L participated in the treatment of this patient; Wu HY, Cao YW, Gao TJ and Fu JL revised the manuscript; All authors have read and approved the final version of the manuscript.
Supported by Natural Science Basic Research Program of Shaanxi Province, No. 2020JQ-939; and Science and Technology Development Incubation Fund Project of Shaanxi Provincial People’s Hospital, No. 2019YXQ-08.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Wei Cao, MD, PhD, Doctor, Department of Electrocardiology, Shaanxi Provincial People’s Hospital, No. 256 West Youyi Road, Xi’an 710068, Shaanxi Province, China. 807422365@qq.com
Received: January 23, 2021
Peer-review started: January 23, 2021
First decision: February 11, 2021
Revised: February 19, 2021
Accepted: March 15, 2021
Article in press: March 15, 2021
Published online: June 6, 2021
Abstract
BACKGROUND

Arrhythmogenic right ventricular (RV) cardiomyopathy is a rare and currently underrecognized cardiomyopathy characterized by the replacement of RV myocardium by fibrofatty tissue. It may be asymptomatic or symptomatic (palpitations or syncope) and may induce sudden cardiac death, especially during exercise. To prevent adverse events such as sudden cardiac death and heart failure, early diagnosis and treatment of arrhythmogenic RV cardiomyopathy (ARVC) are crucial. We report a patient with ARVC characterized by recurrent syncope during exercise who was successfully treated with combined endocardial and epicardial catheter ablation.

CASE SUMMARY

A 43-year-old man was referred for an episode of syncope during exercise. Previously, the patient experienced two episodes of syncope without a firm etiological diagnosis. An electrocardiogram obtained at admission indicated ventricular tachycardia originating from the inferior wall of the right ventricle. The ventricular tachycardia was terminated with intravenous propafenone. A repeat electrocardiogram showed a regular sinus rhythm with negative T waves and a delayed S-wave upstroke from leads V1 to V4. Cardiac magnetic resonance imaging showed RV free wall thinning, regional RV akinesia, RV dilatation and fibrofatty infiltration (RV ejection fraction of 38%). An electrophysiological study showed multiple inducible ventricular tachycardia as of a focal mechanism from the right ventricle. Endocardial and epicardial voltage mapping demonstrated scar tissue in the anterior wall, free wall and posterior wall of the right ventricle. Late potentials were also recorded. The patient was diagnosed with ARVC and treated with combined endocardial and epicardial catheter ablation with a very satisfactory follow-up result.

CONCLUSION

Clinicians should be aware of ARVC, and further workup, including imaging with multiple modalities, should be pursued. The combination of epicardial and endocardial catheter ablation can lead to a good outcome.

Keywords: Arrhythmogenic right ventricular cardiomyopathy, Endocardial catheter ablation, Epicardial catheter ablation, Syncope, Exercise, Case report

Core Tip: Classification of cardiomyopathy based on clinical phenotype is critical. In general, arrhythmogenic right ventricular cardiomyopathy should be suspected in patients with right ventricular arrhythmia, a family history of arrhythmogenic right ventricular cardiomyopathy or sudden death or abnormal electrocardiogram features such as repolarization or depolarization abnormalities in the right leads. We hope that this case will raise awareness of arrhythmogenic right ventricular cardiomyopathy.