gms | German Medical Science

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by changes in myocardial tissue structure of the right ventricle (RV) and recurrent ventricular tachycardia frequently resulting in sudden cardiac death. It is usually diagnosed in the adolescence, presenting with syncopal episodes and sustained ventricular tachycardia. Magnetic resonance imaging (MRI) has been shown to be an essential tool for the non-invasive diagnosis of ARVC. It allows detailed visualization and depicts both functional and structural abnormalities of the heart. However, no data are available about the occurrence of ARVC in elderly patients using MRI.

Methods/Results: We report on a 77-year-old male who developed recurrent ventricular tachycardia with dizziness and syncope. There was no history of cardiac diseases, and relevant coronary artery disease was excluded by coronary angiography. MRI was performed showing (a) dilation of the right ventricle with an (b) aneurysmatic ectasia of the RV lateral wall, resulting in (c) dyskinetic bulges during contraction. There was a (d) “Tellerstapel” phenomenon seen in the RV apex (Figure 1 [Fig. 1]). High-intensity areas indicated (e) fatty infiltration of the RV lateral wall during T1-weighted and (f) edema of the RV apex during T2-weighted conventional spin-echo images. Additionally, the patient showed (g) epsilon-potentials and (h) inversion of T wave in the precordial leads, and (i) sustained LBBB-type ventricular tachycardia during hospitalisation. Thus, 5 major (a-c, e, g) and 4 minor criteria (d, f, h, i) were fulfilled confirming the diagnosis of ARVC in this patient.

Conclusion: ARVD should be considered in patients of all ages who present with recurrent ventricular tachycardia. The MRI criteria are very important for the diagnosis of this condition, as most of them seem to represent major ARVD criteria. Thus, MRI findings should be regularly considered to diagnose ARVD, especially in the elderly patients.