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Arrythmogenic right ventricular cardiomyopathy/dysplasia and “idiopathic” premature ventricular contractions: diagnosis in young patients

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Idiopathic arrhythmias are heart rhythm and conduction abnormalities in patients without structural heart abnormalities, or more precisely, arrhythmias with unknown causes. However, a complex examination of the patient reveals the cause of arrhythmia in more than 94% cases. A patient, 28, with complains of palpitations, was referred to our clinic with a diagnosis of “idiopathic premature ventricular contractions”. The 24-hour ECG monitoring detected 14326 premature ventricular contractions. The standard clinical tests did not reveal the cause of arrhythmia. Further diagnostic evaluation was focused on verification/exclusion of congenital cardiomyopathies and chronic myocarditis. The heart MRI revealed significant right ventricular dilatation and regional dyskinesia. The signal averaged ECG found late potentials. Thus, there are at least 1 major and 2 minor criteria of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) according to the modified 2010Task Force Criteria. In addition, a concomitant chronic immune myocarditis was diagnosed, which is typical for ARVD. This diagnosis was based on triple elevated titers of anti-heart antibodies and late enhancement revealed by magnetic resonance imaging. Consequently, idiopathic arrhythmias in young patients should not be considered a final diagnosis, but should be a signal for further careful clinical evaluation.

About the Authors

I. A. Khakuasheva
I.M. Sechenov First MSMU (Sechenov University)
Russian Federation

Y. A. Lutokhina
I.M. Sechenov First MSMU (Sechenov University)
Russian Federation

O. V. Blagova
I.M. Sechenov First MSMU (Sechenov University)
Russian Federation


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