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World J Cardiol. Mar 26, 2026; 18(3): 117999
Published online Mar 26, 2026. doi: 10.4330/wjc.v18.i3.117999
Arrhythmogenic right ventricular cardiomyopathy with atrial tachycardia and sick sinus syndrome: A case report
Ao Li, Yong-Jie Zhu, Xiao-Xue Ma, Yan Jin, Jun Yang, Qiu-Ting Feng
Ao Li, Yong-Jie Zhu, Qiu-Ting Feng, Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
Ao Li, Yong-Jie Zhu, Xiao-Xue Ma, Yan Jin, Jun Yang, Qiu-Ting Feng, Department of Cardiology, Jiangnan University Medical Center (Wuxi No. 2 People’s Hospital), Wuxi 214000, Jiangsu Province, China
Co-first authors: Ao Li and Yong-Jie Zhu.
Co-corresponding authors: Jun Yang and Qiu-Ting Feng.
Author contributions: Li A and Zhu YJ contributed equally to this work and share first authorship; both authors were involved in study design, clinical data collection and analysis, and manuscript drafting; Li A collected the clinical data and drafted the manuscript; Zhu YJ assisted with data collection and manuscript revision; Ma XX and Jin Y analyzed imaging and electrophysiological data and revised the manuscript; Yang J and Feng QT contributed equally as co-corresponding authors of this manuscript. Both authors conceived and designed the study. Yang J was primarily responsible for the clinical management of the patient, including diagnostic evaluation, therapeutic decision-making, and peri-procedural care; Yang J performed the electrophysiological study and radiofrequency catheter ablation, interpreted intracardiac electrograms and electroanatomic mapping data, and made critical intra-procedural decisions to ensure procedural efficacy and safety; Yang J also contributed substantially to the interpretation of electrophysiological findings and revised the manuscript with a focus on arrhythmia mechanisms, ablation strategy, and procedural outcomes. Feng QT provided overall academic supervision and was responsible for the conceptual framework and scientific direction of the study; Feng QT guided the integration of clinical presentation, electrophysiological characteristics, imaging findings, and the pathological implications of atrial involvement in arrhythmogenic right ventricular cardiomyopathy; Feng QT conducted a comprehensive literature review, refined the scientific narrative, critically revised multiple versions of the manuscript to improve its academic rigor, clarity, and clinical relevance, and was responsible for the manuscript submission process and all correspondence with the journal. The close collaboration between Yang J and Feng QT was indispensable for the successful completion and publication of this case report. All authors have read and approved the final manuscript.
Supported by the Wuxi Municipal Health Commission Fund, China, No. CXTDPY2021004, No. M202423, No. M202328, and No. Q202406.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Qiu-Ting Feng, PhD, Chief Physician, Department of Cardiology, Jiangnan University Medical Center (Wuxi No. 2 People’s Hospital), No. 68 Zhongshan Road, Wuxi 214000, Jiangsu Province, China. fqt_810905@163.com
Received: December 22, 2025
Revised: January 12, 2026
Accepted: February 10, 2026
Published online: March 26, 2026
Processing time: 92 Days and 18.2 Hours
Abstract
BACKGROUND

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy that may involve the right ventricle, left ventricle, or both. To the best of our knowledge, the combination of ARVC with sick sinus syndrome, para-Hisian focal atrial tachycardia (AT), and demonstrable atrial myocardial involvement has not been previously reported.

CASE SUMMARY

A 57-year-old male was hospitalized with palpitations and was diagnosed with definite ARVC in 2021. He presented initially with sustained ventricular tachycardia and declined implantable cardioverter-defibrillator implantation. Later he developed focal AT with 2:1 atrioventricular conduction and ischemic stroke. During hospitalization endocardial substrate ablation of extensive low-voltage and scarred areas along the right ventricle free wall was performed, followed by successful ablation of a para-Hisian focal AT. A post-ablation electrophysiological study revealed prolonged sinus node recovery time (1660 milliseconds), marked sinus bradycardia after AT termination, and extensive right atrial low-voltage and scarred areas involving the free wall, posterior wall, and sinus node area. Sick sinus syndrome and right atrial myocardial involvement were diagnosed. As of the most recent follow-up in 2025 he had suffered two ischemic strokes with no ventricular tachycardia.

CONCLUSION

A thorough assessment of atrial involvement is essential for ARVC patients.

Keywords: Electrophysiology; Arrhythmogenic right ventricular cardiomyopathy; Sick sinus syndrome; Atrial tachycardia; Case report

Core Tip: This case highlights a rare arrhythmogenic right ventricular cardiomyopathy (ARVC) with sick sinus syndrome, para-Hisian focal atrial tachycardia, and extensive right atrial myocardial scarring confirmed by electroanatomic mapping. Beyond ventricular involvement, the patient demonstrated profound atrial electrical and structural remodeling, sinus node dysfunction and ischemic strokes despite successful ventricular tachycardia control. Therefore, atrial myocardial involvement in ARVC may have important clinical implications and systematic evaluation for arrhythmic and thromboembolic risk is valuable.