Idiopathic left ventricular aneurysm and sudden cardiac death in young adults.
OBJECTIVE
We report three young patients presenting with life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) and/or survived sudden cardiac arrest, who were admitted to our institution for further diagnostic evaluation.


RESULTS
In all patients, idiopathic left ventricular (LV) aneurysms were identified after a detailed non-invasive and invasive evaluation. Sustained VT/VF was inducible during programmed ventricular stimulation in two of the three patients. Left ventricular aneurysms were depicted and characterized by various imaging modalities (echocardiography, magnetic resonance imaging, LV angiography). To elucidate the pathogenesis further, both myocardial viability and regional sympathetic innervation were assessed by radionuclide imaging techniques. Defects of innervation and metabolism were documented in the area of the aneurysm but distal to the aneurysm there were no signs of downstream denervation.


CONCLUSIONS
Life-threatening arrhythmias may be the first manifestation of an idiopathic LV aneurysm, which can be reliably diagnosed with modern imaging techniques. Radionuclide imaging may yield additional information as to the involvement of the autonomic nervous system potentially associated with arrhythmogenesis. Management strategies in patients with an idiopathic LV aneurysm range from antiarrhythmic drug treatment, implantation of an automatic cardioverter-defibrillator to surgical aneurysmectomy.
Paul
Matthias
M
Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany. mapaul@uni-muenster.de
Schäfers
Michael
M
Grude
Matthias
M
Reinke
Florian
F
Juergens
Kai Uwe
KU
Fischbach
Roman
R
Schober
Otmar
O
Breithardt
Günter
G
Wichter
Thomas
T
D000328:Adult; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D004562:Electrocardiography; D005260:Female; D006322:Heart Aneurysm / Q000150:complications* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006352:Heart Ventricles / Q000294:innervation / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D013564:Sympathetic Nervous System / Q000502:physiology; D017180:Tachycardia, Ventricular / Q000150:complications / Q000473:pathology / Q000503:physiopathology