Possible ARVD

Hi I am a healthy 23 year old female.  I don't smoke, rarely drink and stay fairly active.  5 years back i noticed I would get SOB, nauseated and felt like my heart started racing.  These episodes lasted about 5 minutes and was more of an annoyance than anything.  I recently went to a cardiologist because the last episode lasted over an hour and I felt very close to passing out.  I got SOB, nauseated, pale, sweaty and was very fatigued afterwards.  My EKG showed a RBBB, stress test was normal and ECHO showed enlargement of my right ventricle.  My DR wanted me to get an MRI to rule out ARVD.  The MRI showed mild dilation and focal wall hypokinesis of right ventricle, EF of about 50%.  I went to see an EP Dr. He did an EP study hoping at the most to find SVT.  He did not induce SVT or VT but he did say he induced VFIB twice and had to shock me out of it.  He did also mention he wasn't too aggressive during the study. He seemed a bit confused by the findings and actually seemed a little bit worried.  I work with him a lot at the hospital and this was the first time I saw him, I guess you could say, out of his league.  By the next week he was telling me he was leaning towards a false positive but was waiting to hear back from some other doctors. Its been 3 weeks and he hasn't said anything else about it.  They have only caught a small episode at the hospital and I went from the 50's to sinus tach of 160's back down to the 50's with normal BP. I did get sympomatic just like all the other episodes.  I have yet to find anything specific to trigger these epidsodes. I cut out caffeine and really just any stimulant.  Do you think it could be a false positive if he was able to induce VFIB twice?  And could he tell if there was some structural issues with my right ventricle during the EP study?  Im just a bit nervous now because I have had another episode and being a nurse I know way too much and not enough at the same time.  Thanks for you time and your help.

[Michael J. McWilliams, M.D.]

It depends on how he induced the vfib.  VTach is more common than VFib with ARVD.  VFib is considered a non specific finding during an ep study.  Unless a full RV map was done to measure voltage and look for scar (unlikley for an EP study), not much info is obtained from the EP study about the RV.

If you are looking for ARVD, you need someone very experienced at reading the MRI.  I would refer you to an academic center to sees more ARVD.

The diagnosis of ARVD is based on specific criteria.   You don't sound like you have very many of them.  I would go to someone that specializes in ARVD and let them render an opinion ---- Hugh Calkins at Hopkins is very good.