ELECTROPHYSIOLOGY
Idiopathic left ventricular aneurysm and sudden cardiac death in young adults
1 Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany; 2 Department of Nuclear Medicine, University Hospital of Münster Germany; 3 Department of Clinical Radiology, University Hospital of Münster Germany
Aims We report three young patients presenting with life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) and/or survived sudden cardiac arrest, who were admitted to our institution for further diagnostic evaluation.
Methods and results In all patients, idiopathic left ventricular (LV) aneurysms were identified after a detailed non-invasive and invasive evaluation. Sustained VT/VF was inducible during programmed ventricular stimulation in two of the three patients. Left ventricular aneurysms were depicted and characterized by various imaging modalities (echocardiography, magnetic resonance imaging, LV angiography). To elucidate the pathogenesis further, both myocardial viability and regional sympathetic innervation were assessed by radionuclide imaging techniques. Defects of innervation and metabolism were documented in the area of the aneurysm but distal to the aneurysm there were no signs of downstream denervation.
Conclusion Life-threatening arrhythmias may be the first manifestation of an idiopathic LV aneurysm, which can be reliably diagnosed with modern imaging techniques. Radionuclide imaging may yield additional information as to the involvement of the autonomic nervous system potentially associated with arrhythmogenesis. Management strategies in patients with an idiopathic LV aneurysm range from antiarrhythmic drug treatment, implantation of an automatic cardioverter–defibrillator to surgical aneurysmectomy.
Key Words: Left ventricle, Aneurysm, Sudden death, Cardiomyopathy, Sympathetic nervous system
* Corresponding author. Tel: +49 251 83 47581; fax: +49 251 83 47864. E-mail address: mapaul{at}uni-muenster.de