Advances in Hybrid Management Strategies for Arrhythmogenic Cardiomyopathy Progression in an Amateur Athlete

Arrhythmogenic cardiomyopathy (ACM) is a rare inherited disorder leading to ventricular arrhythmias and sudden cardiac death.

A middle-aged male amateur cyclist with ventricular arrhythmias complicated by myocardial infarction with non-obstructive coronary arteries during fast ventricular tachycardias recurrence underwent a successful endocardial ablation, resulting in a prolonged arrhythmia-free period. ACM was suspected, although its diagnostic criteria were not met at that time. In 2024, ventricular tachycardia recurred, prompting multidisciplinary re-evaluation. Hybrid epicardial mapping and cryoablation resulted in complete acute noninducibility of VT. The patient has remained arrhythmia-free for over 9 months.

This case highlights the evolving nature of ACM and the benefits of hybrid epicardial ablation techniques. The novel cryoablation system offers precise lesion creation, especially in challenging anatomical locations.

Dynamic reassessment and personalized, multidisciplinary management are crucial in ACM. In complex cases, hybrid imaging, epicardial mapping, myocardial biopsy, and cryoablation may enhance patient safety and treatment efficacy.