Unexpected Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy After Routine Preoperative Evaluation Leads to Life-Saving Intervention

Background

A healthy 44-year-old woman presented for preoperative evaluation of planned bunionectomy. Electrocardiogram showed T-wave inversions in leads V₁ to V₅ and epsilon waves in precordium prompting further evaluation.

Case Summary

Imaging studies and genetic testing revealed diagnosis of arrhythmogenic right ventricular cardiomyopathy. Patient met Class IIb indication for primary prevention with implantable cardioverter-defibrillator (ICD). Despite weak guideline indication, shared decision-making with the patient led to ICD implantation. Six months later, she had a ventricular tachycardia arrest resulting in ICD shock and return to sinus rhythm.

Discussion

Routine preoperative evaluation led to the diagnosis of a rare pathology. Prompt evaluation and intervention using shared decision-making led to a life-saving intervention.

Take-Home Messages

Utilization of guidelines in conjunction with patient-centered therapy is the best approach to provide optimal care and prevent mortality in rare instances like this case for ICD placement after arrhythmogenic right ventricular cardiomyopathy diagnosis.