Aneurysms and ARVD

Hello, I am a 24 year old female who use to have 24000-35000 PVC's from the RVOT a day.  I have had many episodes of syncope, near syncope, dizzyness, extreme weakness, racing heart, chest pain etc.  I also have a brother that passed away suddenly at only a few months of age from what was thought to be SIDS.  My cardiologist then ordered a cardiac MRI (at canada's top cardiovascular center).  The initial report stated that they found "localized RV aneurysms on the RV free wall".  Because i had now met one major criteria for ARVC/D (the aneurysms) and one minor criteria (# of PVC's) and have a positive family history for SCD, he thought an ICD was needed.  I was then sent back to the cardiovascular center where they preformed an signal averaged ECG which came back normal.  They then did a heart cath, angiogram and RV angiogram which they said were slightly abnormal (no more details were given). They then did an EP study which they said was not consistant with ARVC.  Instead, they found RVOT PVC's and AV nodal reentry tachycardia, both which they were able to sucessfully ablate.  The cardiologists then went and looked at the MRI themselves and not just the report.  They said that they are not certain that i actually have an Aneurysm.  They said that as far as they are concerned they do not believe that i have ARVC and that they i should have an MRI done annually to make sure they were not too quick to rule out ARVC.  So now i am confused.  Is it possible for the MRI reader (who is considered the best in canada) to initially say that there was an  RV aneurysm and then later have my cardiologists say that they are likely non existent?  If i do not have an aneurysm, why would the initial report state that i did?  Could he have mistaken it for something else?  Should i just trust them and forget about ARVC until the next MRI, one year from now?  Any information or insight would be greatly appriciated!

[Michael J. McWilliams, M.D.]

Is it possible for the MRI reader (who is considered the best in canada) to initially say that there was an  RV aneurysm and then later have my cardiologists say that they are likely non existent?

I can certainly understand your confusion and frustration.  This is a very difficult diagnosis to make and sometimes the criteria that are used to make the decision are not black and what (yes or no) answers -- they are a continuum.  For example, people with ARVD are usually not born with RV aneurysms.  They slowly develop over time.  If they check an MRI now and it is negative, there is still a chance you may develop one over time or that something that they thought was an aneurysm  was a normal variant and does not develop further.

In general, each case must be evaluated as a whole and not parts -- the pieces must fit together. What they are telling you now is that they do not think that you have ARVD.  Unfortunately, sometimes all we can do is wait -- I don't expect you to be satisfied with that answer.  The other option is to contact a specialty center, like The Johns Hopkins Hospital and ask them to have their specialist over read the MRI for a second opinion.  This will cost money but may provide piece of mind, but it also might not.

I hope this answers your questions.  good luck and thanks for posting.

please see the previous post today because it also discusses ARVD.