Chemotherapy-Induced Arrhythmogenic Right Ventricular Cardiomyopathy

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disorder characterized by fibrofatty replacement of the right ventricular myocardium. Anthracycline-induced cardiotoxicity typically manifests as left ventricular dysfunction; however, we present a unique case of an acquired ARVC phenotype secondary to anthracycline chemotherapy exposure. CASE SUMMARY: A 74-year-old man developed recurrent exertional syncope 8 months after completing rituximab, cyclophosphamide, hydroxydaunorubicin (an anthracycline that is also known as doxorubicin), oncovin, and prednisone chemotherapy. He met 3 major 2010 Revised Task Force Criteria for definite ARVC, despite negative genetic testing and absence of family history. He underwent dual-chamber implantable cardioverter-defibrillator implantation with complete resolution of syncopal episodes. DISCUSSION: Recognition of acquired ARVC after anthracycline exposure broadens the spectrum of chemotherapy-related cardiomyopathies and calls for vigilance in patients with unexplained right ventricular dysfunction or arrhythmias after chemotherapy. TAKE-HOME MESSAGES: Anthracyclines may cause isolated right ventricular dysfunction mimicking ARVC. Clinicians should maintain vigilance for right ventricular dysfunction or arrhythmias in patients after anthracycline therapy.