Interesting Arrhythmogenic Right Ventricular Cardiomyopathy: A Diagnosis beyond Criteria?

Abstract

A normotensive, euglycemic 24-year-old male presented with presyncope. There was no history of similar episodes or loss of consciousness. No similar family history was noted. General clinical and cardiovascular examination was unremarkable. Electrocardiogram done showed wide complex tachycardia with a left bundle branch block morphology suggestive of ventricular tachycardia. The tachycardia spontaneously reverted to normal sinus rhythm. The patient subsequently had sinus bradycardia with a heart rate of 58/min and demonstrated an epsilon wave in the inferior and right-sided chest leads. His cardiac magnetic resonance imaging showed a dilated right atrium and ventricle with no fibrofatty infiltration. This patient did not fulfil the criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) according to the 2020 criteria. He qualified for suspected ARVC. However, according to the Heart Rhythm Society guidelines of 2019, he qualified as ARVC as he met two major criteria. We report this case as we feel that the criteria for diagnosis of ARVC may not warrant strict adherence. A strong clinical suspicion is required in addition for diagnosis.