Vetricular tachycardia in a patient with left ventricular noncompaction cardiomyopathy

Introduction: Left ventricular noncompaction cardiomyopathy (LVNC) is a relatively rare congenital disorder characterized by prominent, excessive trabeculation in a ventricular wall segment and deep intertrabecular recesses perfused from the ventricular cavity. This is possibly due to an arrest of intrauterine compaction of the myocardial fibres in the absence of any other structural heart disease. The clinical presentation varies ranging from asymptomatic patients to patients who develop ventricular systolic dysfunction, thromboembolism, malignant tachy-arrhythmias and even sudden cardiac death.
Case presentation: We present the case of 46 years old male patient, who was referred to Cardiology Department of the Clinical Rehabilitation Hospital in Cluj-Napoca for palpitations triggered by intense physical effort. The physical examination revealed a resting blood preasure of 120/70 mmHg and a heart rate of 50 beats/min, normal heart sounds, without any murmurs and the routine laboratory test results revealed hypo-cholesterolemia. The 12-lead electrocardiogram (ECG) showed sinus rhythm without any ST-T changes. The transthoracic echocardiogram revealed hypokinesia of the anterior and lateral walls, a depressed left ventricle ejection fraction of 46% and mild mitral regurgitation. The exercise stress test performed before admission, revealed an exercise induced monomorphic ventricu-lar tachycardia and the patient received treatment with beta-blockers (Bisoprolol 1.25 mg 2×1/zi). Results of a cardiac magnetic resonance and cardiac computed tomography scan study included prominent trabeculati-ons seen in the left ventricle. The ratio of noncompacted-to/compacted myocardium was >2. Investigations continue with an electrophysiology study but the sus-tained ventricular tachycardia was not inducible after extrastimuli, rapid ventricular pacing or additional adrenaline infusion. The patient continued treatment with beta-blockers in higher dose (Bisoprolol 2.5 mg 2×1/zi) without recurrences of the ventricular tachycardia, during the follow-up period.
Conclusions: Exercise-induced ventricular tachycardia can be a clinical presentation in patients with LVNC. Beta-blockers are an option for treatment in patients with LVNC, in order to prevent exercise-induced ven-tricular tachycardia.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)