Advances in Hybrid Management Strategies for Arrhythmogenic Cardiomyopathy Progression in an Amateur Athlete.

BACKGROUND

Arrhythmogenic cardiomyopathy (ACM) is a rare inherited disorder leading to ventricular arrhythmias and sudden cardiac death.

CASE SUMMARY: A middle-aged male amateur cyclist with ventricular arrhythmias complicated by myocardial infarction with non-obstructive coronary arteries during fast ventricular tachycardias recurrence underwent a successful endocardial ablation, resulting in a prolonged arrhythmia-free period. ACM was suspected, although its diagnostic criteria were not met at that time. In 2024, ventricular tachycardia recurred, prompting multidisciplinary re-evaluation. Hybrid epicardial mapping and cryoablation resulted in complete acute noninducibility of VT. The patient has remained arrhythmia-free for over 9 months.

DISCUSSION: This case highlights the evolving nature of ACM and the benefits of hybrid epicardial ablation techniques. The novel cryoablation system offers precise lesion creation, especially in challenging anatomical locations.

TAKE-HOME MESSAGES: Dynamic reassessment and personalized, multidisciplinary management are crucial in ACM. In complex cases, hybrid imaging, epicardial mapping, myocardial biopsy, and cryoablation may enhance patient safety and treatment efficacy.