Arrhythmogenic right ventricular cardiomyopathy presenting with intra-operative aborted sudden cardiac death and Takotsubo-like left ventricular functional abnormalities

A 46-year-old female under treatment with flecainide for atrial fibrillation developed cardiopulmonary arrest secondary to ventricular fibrillation during an elective laparoscopic cholecystectomy. The ECG after cardioversion demonstrated a prolonged QTc interval with elevated cardiac enzymes. A diagnosis of Takotsubo cardiomyopathy was made after angiography demonstrated normal coronary arteries with characteristic ballooning of the left ventricle seen on the left ventriculogram. However, right ventricular biopsy revealed significant fibrofatty infiltration of the myocardium. Treatment with flecainide and early features of arrhythmogenic right ventricular dysplasia may have predisposed the patient to ventricular fibrillation during the transient left ventricular dysfunction of Takotsubo cardiomyopathy.