Arrhythmogenic right ventricular dysplasia: a possible cause of sudden incapacitation

Arrhythmogenic right ventricular dysplasia (ARVD) is an important cause of sudden death in the young. The classic presentation is with sustained ventricular tachycardia, with an electrocardiographic pattern of a left bundle branch block, but a proportion of the patients may present as sudden cardiac death. Establishing the diagnosis in aviators may be particularly important since it may prevent sudden incapacitation. We present a case of an aviator with ARVD, in whom the diagnosis was delayed despite an abnormal ECG pattern witnessed over 20 yr. The aviator presented with symptomatic sustained ventricular tachycardia at the age of 46 after nearly 3 decades of active flight duty as a rotary wing pilot in the Israeli air force. This case illustrates the potential of ARVD to result in in-flight incapacitation and emphasizes the need to establish the diagnosis early, particularly in aviators.