Is it worth while to be a fan of Fradi in the Groupama Arena?
█ Case report
Borbola József1, Sári Csaba1, Som Zoltán1, Suhai Ferenc2, Csepregi András1
1Gottsegen György Országos Kardiológiai Intézet, Felnőtt Kardiológiai Osztály, Budapest
2Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
A 29 years old Fradi-fan suffered aborted sudden cardiac (arrhythmic) death during the half-time of an exciting Fradi football game in the Groupama Arena. The fan was successfully resuscitated by the OMSZ ambulance team on the spot. In the background of this event, the cardiological, clinical work-up of the fan revealed a rare, left ventricular myocardial disease entity, namely the arrhythmogenic left ventricular cardiomyopathy (ALVC).
The ALVC is a progressive myocardial arrhythmogenic disease based on the mutations of mostly desmosomic and extradesmosomic proteins encoding genes, which is capable of inducing ventricular fibrillation in the young. The criteria of the classical forms of the arrhythmogenic right ventricular cardiomyopathy cannot be applied to his variant phenotype The main distinctive features of the dominant ALVC variant are as follows: (1) ECG T wave inversions in the (infero)laterals leads; (2) cardiac MR morpho-functional imaging is consistent with a left ventricle showing mild systolic dysfunction, no (or mild) dilatation, and a great amount of inferolateral, septal, subepicardial/mid-myocardial (non-ischemic type) late gadolinium enhancement. Normal right ventricle; (3) ventricular arrhythmias reflecting the origin from the left ventricle; (4) increased susceptibility to cardiac arrest by ventricular fibrillation at a young age. The hospital work-up of this young Fradi-fan verified the ALVC entity. Treatment strategies focused on lifestyle modifications (restriction of stressful sport activity), controlling arrhythmias with adrenerg beta-blocker therapy and preventing sudden cardiac (arrhythmic) death with an ICD.
In connection with the clinical diagnostic work-up of aborted sudden cardiac (arrhythmic) death in a young person, one should think of this rare, non-classical, arrhythmogenic ventricular cardiomyopathy subtype (ALVC), predominantly effecting the left ventricle. The new Groupama Arena is proved to be a safe sport establishment not only for the football players, but also for the spectators.