Unexpected finding in an adult with ventricular fibrillation and an accessory pathway: non-compaction cardiomyopathy

Abstract

IntroductionIn this report, we demonstrate a patient presenting with anout-of-hospital cardiac arrest due to ventricular fibrillation(VF). At the hospital the presence of an accessory path-way could be seen on the surface electrocardiogram(ECG). Surprisingly, cardiac imaging also showed thepresence of isolated left ventricular non-compaction car-diomyopathy (INVM).INVMwasfirstdescribedin1984byEngberdingetal.as an unclassified cardiomyopathy [1]. It is assumed to bethe result of an arrest of the compaction process duringthe normal development of the heart (week 5–8). InINVM, the spaces within the intertrabeculated meshworkpersist with deep recesses and no other cardiac abnormal-ities [1, 2]. Clinical presentation of INVM includesheart failure, thromboembolic events and arrhythmias[1, 3, 5, 7]. Conduction abnormalities and arrhythmiasobserved in INVM patients are left or right bundlebranch block, supraventricular tachycardia and ventric-ular tachycardia [1–3, 5–10].However,thepresenceofanaccessorypathwayandINVMin one patient with VF has never been described before.Case reportA 19-year-old female presented to the emergency depart-ment after an out-of-hospital cardiac arrest due to VF.After alcohol consumption she jumped off a 1 m highpier into the water. While dressing she complained ofdizziness, palpitations and breathlessness. She collapsednear her car and lost consciousness. The paramedics ar-rived within 7 min and provided cardiopulmonary resus-citation. VF was documented on arrival (Fig. 1). Afterthree DC shocks sinus rhythm resumed and due to a lowGlasgow Coma Score she was intubated. At the intensivecardiac care unit therapeutichypothermia was induced for24 h. She regained consciousness without any signs ofpersistent neurological injury. Anamnestic there were noprevious palpitations or (near) collapses. The patient hadnoted that she was relatively quickly exhausted duringphysical exercise. Despite this, she played field hockeywithout any restraints. Her family history was negative forcardiovascular diseases, arrhythmias or sudden cardiacdeath. The 12-lead ECG after defibrillation showed pre-