Electrical storm as initial presentation of arrhytmogenic right ventricular cardiomyopathy in an elderly woman

Arrhythmogenic right ventricular cardiomyopathy in an octogenarian presenting with ventricular tachycardia

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is one of the major causes of sudden death. Myocardial atrophy with subsequent fibro-fatty replacement predominantly affects right ventricular myocardium and results in global and regional dysfunction as well as areas of slow conduction and dispersion of refractoriness, which are prerequisites for reentrant ventricular tachyarrhythmias. ARVC is commonly presented in patients <65 years old. However, few cases of elderly people suffering from this cardiomyopathy have been reported in the literature. We present a case of an 82-year-old woman with sustained ventricular tachycardia due to first diagnosed ARVC.

Unusual presentation of a patient with arrhythmogenic right ventricular dysplasia treated with a Glenn shunt

Clinically, arrhythmogenic right ventricular dysplasia (ARVD) usually presents with ventricular arrhythmias, and unusual presentations were reported as acute coronary syndrome, heart failure and electrical storm. Taking all this different presentations and treatments in to account, we report a case of ARVD presenting with central cyanosis and clubbing simulating congenital heart disease. Besides this unusual presentation, the patient underwent also an unusual operation for this kind of abnormality, which cured the cyanosis completely.

Epidemiology of fat replacement of the right ventricular myocardium determined by multislice computed tomography using a logistic regression model

PURPOSE

We frequently observe fat replacement (FR) of the anterior wall of the right ventricular myocardium (RVM), but its epidemiological significance is not clear.

METHODS AND MATERIALS

49 consecutive subjects (28 males, 36-83 years old, median 67) underwent enhanced ECG-gated multislice CT (Light speed ultra 16, General Electrics, WI) and we retrospectively analyzed the presence of FR of RVM. A logistic model for predicting FR of RVM was constructed using age, sex, hypertension [HT], diabetes mellitus [DM], hyperlipidemia [HL] smoking, obesity (body mass index >25.0) and calcified and non-calcified plaques of coronary arteries (CA).

RESULTS

FR of RVM was detected in 21 subjects (12 males, 51-78 years old, median 67), 76% of whom had HT, 38% DM, 43% HL, 48% smoking history, 52% were obese, and 76% had calcified and 24% had non-calcified plaques of CA. Only obesity was significantly higher in FR (p<0.05). A logistic regression model showed, although there was a close association between obesity and an increased incidence of FR, it did not reach statistical significance (p=0.0515, relative risk 5.11).

CONCLUSIONS

Obesity is significantly more common in cases of FR, and despite a negative multivariable analysis, may influence FR in the RVM. FR in obesity may occur independently of clinically-significant arrhythmia, which is different from ARVC. Thus, even with FR, obesity must be considered as a diagnosis before ARVC.

Multiple appropriate and spurious defibrillator shocks in a patient with right ventricular cardiomyopathy

An implantable cardioverter defibrillator (ICD) has been implanted in a 69-year-old patient with arrhythmogenic right ventricular cardiomyopathy (ARVC) for treatment of syncopal ventricular tachycardia (VT). Two types of ICD-related emergencies complicated the clinical course within 15 months. The first arrhythmic event occurred 3 months after ICD implantation as electrical storm with repetitive fast VT, resulting in 87 consecutive shocks at maximal output. Intravenous administration of amiodarone and reprogramming of the device were the measures to control VT. A year later, the patient experienced a cluster of 97 inappropriate shocks. Lead insulation failure produced electrical noise on the ventricular sensing channel and was misidentified as ventricular fibrillation (VF). The depleted ICD and the dual-coil lead were explanted and replaced by a new system. Multiple ICD shocks constitute a medical emergency in ICD patients, which requires immediate device interrogation for differentiation of appropriate and spurious discharges.