A case of arrhythmogenic right ventricular cardiomyopathy without ventricular arrhythmias

We submit a case report of a 21-year-old man admitted to our emergency room for acute right heart failure. Arrhythmogenic right ventricular cardiomyopathy (ARVC) was diagnosed but ventricular arrhythmias have never been detected. On the basis of the diagnosis of ARVC and for the frequent episodes of symptomatic bradycardia, the patient underwent implantation of a biventricular defibrillator (CRT-D). In ARVC symptoms usually appear between the ages of 30–50. Especially in young patients the most common clinical presentation of ARVC are palpitations and syncope due to ventricular tachycardia with left bundle branch morphology. In cases of older patients in whom the disease has been described, the clinical presentation is mainly represented by signs and symptoms of right or biventricular heart failure. Our case report shows how, in young patients, this disease may present at the beginning as acute right, heart failure, without ventricular arrhythmias but with episodes of symptomatic bradycardia that, require the use of cardiac resynchronization therapy to avoid the well-known long-term adverse effects of right ventricular pacing.