Arrhythmogenic right ventricular cardiomyopathy characterized by recurrent syncope during exercise:A case report  

作　　者：Hao-Yu Wu Yi-Wei Cao Tian-Jiao Gao Jian-Li Fu Lei Liang 

机构地区：[1]Department of Cardiology,Shaanxi Provincial People’s Hospital,Xi'an 710068,Shaanxi Province,China [2]Department of Electrocardiology,Shaanxi Provincial People’s Hospital,Xi'an 710068,Shaanxi Province,China [3]Department of Gastroenterology,Xi’an Children’s Hospital,Xi’an 710003,Shaanxi Province,China [4]Department of Ultrasonic Diagnosis Center,Shaanxi Provincial People’s Hospital,Xi’an 710068,Shaanxi Province,China

出　　处：《World Journal of Clinical Cases》2021年第16期4095-4103,共9页世界临床病例杂志

基　　金：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.

摘　　要：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.

关 键 词：Arrhythmogenic right ventricular cardiomyopathy Endocardial catheter ablation Epicardial catheter ablation SYNCOPE EXERCISE Case report 

分 类 号：R541.7[医药卫生—心血管疾病] R542.2[医药卫生—内科学]