Arrhythmogenic left ventricular cardiomyopathy managed with CRT-D: A case report

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Arrhythmogenic left ventricular cardiomyopathy (ALVC) presents with nonischemic scar, ventricular arrhythmias, and sudden cardiac death risk.
• Diagnosis typically relies on cardiac magnetic resonance (CMR) and clinical assessment.

Purpose of the Study:

• To present a case of ALVC diagnosed and managed using contemporary methods.
• To emphasize the role of CMR in ALVC diagnosis.
• To support the use of cardiac resynchronization therapy defibrillator (CRT-D) in specific ALVC cases.

Main Methods:

• A 51-year-old male with chest tightness, dyspnea, and syncope underwent diagnostic evaluation.
• Transthoracic echocardiography, CMR, coronary angiography, and genetic testing were performed.
• Guideline-directed medical therapy and CRT-D implantation were initiated.

Main Results:

• CMR revealed findings consistent with ALVC, including fibrosis and thinning.
• The patient experienced a device-pocket infection, successfully managed conservatively.
• Left ventricular ejection fraction improved post-CRT-D, with no malignant ventricular arrhythmias detected.

Conclusions:

• CMR is a valuable tool for diagnosing ALVC.
• Combined CRT-D strategy is effective for left ventricular dysfunction with dyssynchrony in ALVC.
• This case aligns with current guidelines for managing ALVC.