Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by fibrofatty replacement of the right ventricular (RV) myocardium, predisposing to ventricular arrhythmias, RV dysfunction, and sudden cardiac death. Early recognition relies heavily on electrocardiographic (ECG) findings, which often precede overt structural changes. We report a case of a 28-year-old woman presenting with intermittent chest pressure, palpitations, and mild exertional dyspnea. Vital signs were stable, and troponin was normal. Initial 12-lead ECG demonstrated normal sinus rhythm with frequent premature ventricular contractions (PVCs) and T-wave inversions in leads V1–V3. Continuous telemetry revealed frequent runs of monomorphic non-sustained ventricular tachycardia (NSVT) with left bundle-branch block (LBBB) morphology, consistent with RV origin. Transthoracic echocardiography showed RV dilation and regional hypokinesis, with preserved left ventricular size and systolic function. The combination of anterior precordial T-wave inversions, frequent ventricular ectopy of RV origin, and echocardiographic RV abnormalities fulfilled the diagnostic criteria for ARVC. The patient had no sustained or hemodynamically significant VT and no history of syncope or sudden cardiac death. She was initiated on beta-blocker therapy, resulting in significant improvement of arrhythmias, and was recommended for cardiac magnetic resonance imaging and genetic testing for confirmation and familial assessment.
Key electrocardiographic markers of ARVC include: T-wave inversions in V1–V3, ventricular arrhythmias with LBBB morphology, and epsilon waves or prolonged terminal QRS activation in right precordial leads. Early recognition using these ECG clues is essential for risk stratification, guiding further imaging, genetic evaluation, and appropriate management.
Recommended Citation
Jyothi Ramachandran Nair D, Hanif M. Electrocardiographic Clues to Arrhythmogenic Right Ventricular Cardiomyopathy. Transformative Medicine. 2025; 4(4):72-74. doi: https://doi.org/10.54299/tmed/rlsg7122.