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Left ventricular (LV) involvement in the advanced stage of arrhythmogenic right ventricular cardiomyopathy (ARVC) is a well recognized phenomenon. T wave inversion in the lateral leads has been reported to be an electrocardiographic marker of LV involvement. Variants of ARVC that preferentially affect the left ventricle (left-dominant subtype of arrhythmogenic cardiomyopathy) have recently been recognized. We herein report a case in which an initial electrocardiogram that was similar to the left-dominant subtype of arrhythmogenic cardiomyopathy progressed to definitive ARVC over a period of 7 years. This case supports the hypothesis that LV involvement in ARVC may precede the evident onset of significant RV dysfunction.

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A 72-year-old woman with recurrent chest pain was referred for cardiac computed tomography angiography (CTA). Fourteen years previously she had undergone venous coronary artery bypass grafting [saphenous vein grafts (SVGs) to the left circumflex artery and right coronary artery (RCA)]. CTA showed an extracardiac mass (Picture 1,