Arrhythmogenic Cardiomyopathy with Biventricular Involvement and Right Ventricular Thrombosis: A Multi-modality Imaging Approach

Arrhythmogenic cardiomyopathy (AC) is an inherited heart disease characterized by fibro-fatty changes of either ventricles in isolation or in combination. AC may present with ventricular tachycardia (VT), usually with a left bundle branch block (LBBB) morphology (although VT with right bundle branch block morphology may also be encountered). Diagnosis is multi-parametric and cardiovascular magnetic resonance (CMR) holds a key role in showing the typical tissue abnormalities of the ventricles. We report the case of a patient presenting with LBBB VT with multi-modality imaging findings consistent with AC with biventricular involvement and right ventricular (RV) thrombosis. The patient was treated with antiarrhythmics, heart failure therapy, and implantable cardioverter-defibrillator implantation. RV thrombus was treated with new oral anticoagulants.