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Long Term Follow-Up in a Patient with Arrhythmogenic Right Ventricular Dysplasia

Diana-Aurora Bordejevic
Diana-Aurora Bordejevic
, 
Cristina Vacarescu
Cristina Vacarescu
, 
Simina Crisan
Simina Crisan
, 
Lucian Petrescu
Lucian Petrescu
, 
Tudor Luca Constantin
Tudor Luca Constantin
, 
Cristian Mornos
Cristian Mornos
, 
Ciprian Rachieru
Ciprian Rachieru
, 
Emilia Goanta
Emilia Goanta
 e 
Dragos Cozma
Dragos Cozma
   | 03 mag 2022
Romanian Journal of Cardiology's Cover Image
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Article Category: Case Presentation
Pubblicato online: 03 mag 2022
Pagine: 379 - 383
DOI: https://doi.org/10.47803/rjc.2021.31.2.379
Parole chiave
© 2021 Diana-Aurora Bordejevic et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

12-leads ECG. Sinus ryhthm with repetitive ventricular premature beats having a left ventricular branch block pattern, of inferior right ventricular origin; T waves inversions and S waves and in all precordial leads; possible epsilon waves in leads DII, DIII, aVF.
12-leads ECG. Sinus ryhthm with repetitive ventricular premature beats having a left ventricular branch block pattern, of inferior right ventricular origin; T waves inversions and S waves and in all precordial leads; possible epsilon waves in leads DII, DIII, aVF.

Figure 2

Ventricular late potentials: QRS duration = 116 msec, RMS40 = 6uV (<20); LAS40 = 54ms (>38), noise RMS = 0.3uV.
Ventricular late potentials: QRS duration = 116 msec, RMS40 = 6uV (<20); LAS40 = 54ms (>38), noise RMS = 0.3uV.

Figure 3

Transthoracic echocardiographyLeft: parasternal short-axis view at mitral valve level showing right ventricular (RV) dilation with excessive trabeculations. Right: apical four-chamber view showing increased RV diameter at the base and the intracardiac defibrillator lead positioned in the RV apex.
Transthoracic echocardiographyLeft: parasternal short-axis view at mitral valve level showing right ventricular (RV) dilation with excessive trabeculations. Right: apical four-chamber view showing increased RV diameter at the base and the intracardiac defibrillator lead positioned in the RV apex.

Figure 4

MRI performed before implantation demonstrated localised bulging of the RV, excessive trabeculations and increased RV end-diastolic and end-systolic volumes. The patient underwent implantation of a St. Jude Medical single-chamber ICD, programmed in VVI mode with a base frequency of 40 bpm. Antiarrhythmic therapy with amiodarone and beta-blocker was initiated, but the patient missed the follow-ups, did not adhere to the prescribed medication, and did not respect the recommendation of limited physical activity.
MRI performed before implantation demonstrated localised bulging of the RV, excessive trabeculations and increased RV end-diastolic and end-systolic volumes. The patient underwent implantation of a St. Jude Medical single-chamber ICD, programmed in VVI mode with a base frequency of 40 bpm. Antiarrhythmic therapy with amiodarone and beta-blocker was initiated, but the patient missed the follow-ups, did not adhere to the prescribed medication, and did not respect the recommendation of limited physical activity.

Figure 5

Sustained ventricular tachycardia originating in the right ventricle, with an appearance of left bundle branch block, heart rate of 162 beats per minute. Notice fusion QRS complex as patonomonic ECG sign of VT.
Sustained ventricular tachycardia originating in the right ventricle, with an appearance of left bundle branch block, heart rate of 162 beats per minute. Notice fusion QRS complex as patonomonic ECG sign of VT.

Figure 6

ICD interrogation. Intracardiac electrogram showing VF detection and internal cardioversion in this patient. F = ventricular fibrillation window; VS=ventricular sensed beat.
ICD interrogation. Intracardiac electrogram showing VF detection and internal cardioversion in this patient. F = ventricular fibrillation window; VS=ventricular sensed beat.

Figure 7

Three-dimensional mapping system (Carto-3), right lateral view. The scar is located in the lateral free RV wall. The red dots indicate serial ablations applied inside the scar region according to defined targets. ECG 12 derivation represents the VT of inferior axis LBBB like, showing origin inside the scar. Scar definition was done by voltage map (unipolar middle image; bipolar right image).
Three-dimensional mapping system (Carto-3), right lateral view. The scar is located in the lateral free RV wall. The red dots indicate serial ablations applied inside the scar region according to defined targets. ECG 12 derivation represents the VT of inferior axis LBBB like, showing origin inside the scar. Scar definition was done by voltage map (unipolar middle image; bipolar right image).
eISSN:
2734-6382
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
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