Miocardiopatía arritmogénica del ventrículo derecho: Breve revisión de la literatura a propósito de un caso / Arrhythmogenic right ventricular cardiomyopathy: Case report and a brief literature review

Hombre de 51 años admitido en el hospital por presentar palpitaciones y mareos de 2 h de evolución. El electrocardiograma demostró taquicardia regular de QRS ancho y frecuencia cardíaca de 250 lpm, con eje superior y morfología de bloqueo completo de rama izquierda sin descompensación hemodinámica. Se administraron dosis de carga y mantenimiento con amiodarona, revirtiendo a ritmo sinusal. El estudio electrofisiológico demostró el origen ventricular de la taquicardia y su inducibilidad. En la angiografía coronaria no se observaron lesiones significativas en los vasos epicárdicos. Se realizó un ecocardiograma Doppler que presentó cavidades con diámetros y función sistólica y diastólica dentro de los parámetros normales. Ante la sospecha de enfermedad estructural miocárdica se llevó a cabo una resonancia magnética cardíaca contrastada con realce tardío que demostró alteración estructural del ventrículo derecho con incremento de la trabeculación e infiltración fibrograsa parietal y deterioro moderado de su función sistólica, y deterioro leve de la función sistólica del ventrículo izquierdo, lo cual permitió realizar el diagnóstico de miocardiopatía arritmogénica del ventrículo derecho por presentar 2 criterios mayores. Se decidió implantar un cardiodesfibrilador automático, para prevenir la muerte súbita. El paciente evolucionó de manera favorable y fue dado de alta.

A 51-year-old man was admitted to this hospital because of palpitations and a feeling of dizziness for a period of 2h. The electrocardiogram revealed a regular wide-QRS complex tachycardia at a rate of 250 beats per minute, with superior axis and left bundle branch block morphology without hemodynamically decompensation, the patient was cardioverted to sinus rhythm after the administration of a loading and maintenance dose of amiodarone. The elechtrophysiological study showed the ventricular origin of the arrhythmia. In order to diagnose the etiology of the ventricular tachycardia we performed a coronary arteriography that showed normal epicardial vessels, thus ruling out coronary disease. Doppler echocardiography revea- led systolic and diastolic functions of both left and right ventricles within normal parameters, and normal diameters as well. A cardiac magnetic resonance with late enhancement was done, showing structural abnormalities of the right ventricle wall with moderate impairment of the ejection fraction, and a mild dysfunction of the left ventricle. The diagnosis of arrhythmogenic right ventricular cardiomyopathy was performed as 2 major Task Force criteria were met. We implanted an automatic cardioverter defibrillator as a prophylactic measure. The patient was discharged without complications.

[Arrhythmogenic right ventricular cardiomyopathy. Case report and a brief literature review]. / Miocardiopatía arritmogénica del ventrículo derecho. Breve revisión de la literatura a propósito de un caso.

A 51-year-old man was admitted to this hospital because of palpitations and a feeling of dizziness for a period of 2h. The electrocardiogram revealed a regular wide-QRS complex tachycardia at a rate of 250 beats per minute, with superior axis and left bundle branch block morphology without hemodynamically decompensation, the patient was cardioverted to sinus rhythm after the administration of a loading and maintenance dose of amiodarone. The elechtrophysiological study showed the ventricular origin of the arrhythmia. In order to diagnose the etiology of the ventricular tachycardia we performed a coronary arteriography that showed normal epicardial vessels, thus ruling out coronary disease. Doppler echocardiography revealed systolic and diastolic functions of both left and right ventricles within normal parameters, and normal diameters as well. A cardiac magnetic resonance with late enhancement was done, showing structural abnormalities of the right ventricle wall with moderate impairment of the ejection fraction, and a mild dysfunction of the left ventricle. The diagnosis of arrhythmogenic right ventricular cardiomyopathy was performed as 2 major Task Force criteria were met. We implanted an automatic cardioverter defibrillator as a prophylactic measure. The patient was discharged without complications.

Concealed antegrade penetration of the atrio-ventricular node.

We present a patient with paroxysmal, non-sustained atrial tachycardia (AT) on routine surveillance 24-hour Holter post pulmonary vein isolation (PVI). Several asymptomatic ventricular pauses are noted to follow each burst of AT. We postulate that these pauses are due to the resultant concealed penetration of the atrio-ventricular node (AVN) in combination with sino-atrial node overdrive suppression. Recognition of this physiological phenomenon may help avoid unnecessary intervention arising from Holter recording misinterpretation.