Chemotherapy-Induced Arrhythmogenic Right Ventricular Cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disorder characterized by fibrofatty replacement of the right ventricular myocardium. Anthracycline-induced cardiotoxicity typically manifests as left ventricular dysfunction; however, we present a unique case of an acquired ARVC phenotype secondary to anthracycline chemotherapy exposure.

A 74-year-old man developed recurrent exertional syncope 8 months after completing rituximab, cyclophosphamide, hydroxydaunorubicin (an anthracycline that is also known as doxorubicin), oncovin, and prednisone chemotherapy. He met 3 major 2010 Revised Task Force Criteria for definite ARVC, despite negative genetic testing and absence of family history. He underwent dual-chamber implantable cardioverter-defibrillator implantation with complete resolution of syncopal episodes.

Recognition of acquired ARVC after anthracycline exposure broadens the spectrum of chemotherapy-related cardiomyopathies and calls for vigilance in patients with unexplained right ventricular dysfunction or arrhythmias after chemotherapy.

Anthracyclines may cause isolated right ventricular dysfunction mimicking ARVC. Clinicians should maintain vigilance for right ventricular dysfunction or arrhythmias in patients after anthracycline therapy.