IJCS | Volume 31, Nº6, November / December 2018

668 Figure 1 - Cardiac magnetic resonance imaging. (A to D) Cine-MRI, according to the steady-state free precession sequences. (A and B) long-axis, apical four-chamber view (A, diastole, and B, systole); (C and D) short axis (C, diastole and D, systole). Note marked dyskinesia of the free and diaphragmatic walls of the right ventricle in systole and diastole (arrowheads). (E and F) Gradient echo images - inversion recovery, 10 minutes after gadolinium injection: late enhancement areas (arrows) are visualized on the right ventricular free wall, interventricular septum and left ventricular anterolateral wall, with non-ischemic distribution (mid-myocardial). Diastole Systole Late enhancement analysis Late enhancement analysis Augusto et al. Biventricular arrhythmogenic cardiomyopathy Int J Cardiovasc Sci. 2018;31(6)667-671 Case Report The presence of arrhythmogenic cardiomyopathywith biventricular involvement was admitted as the definitive diagnosis. The documentation of several episodes of non- sustained ventricular tachycardia in this context, with biventricular dysfunction, was the reason the patient was referred to receive an implantable cardioverter defibrillator (ICD). Discussion Althoughmost patientswithARVDare asymptomatic, palpitations and syncope are common presenting symptoms. 2 A high level of suspicion is essential in cases where these symptoms are related to frequent premature ventricular contractions or VT episodes (sometimes asymptomatic ones), usuallywith the LBBB configuration (right ventricular origin) and superior axis. 4,5 The classical diagnosis requires the histological evidence of myocardial replacement by fibrous or fibroadipose tissue, predominantly in the RV; 3.6 however, in the clinical context, the revised diagnostic criteria of the 2010 Task Force are applied. 5 The definitive diagnosis is based on the presence of two major criteria; one major criterion and two minor criteria; or four minor criteria from six different categories: global or regional structural changes, depolarization abnormalities, repolarization abnormalities, arrhythmias, histological findings, family history/genetic study (Chart 1). Our case is noteworthy due to the presence of non- sustained VT, premature ventricular contractions with complete LBBB and superior axis pattern, as well as evidence of right ventricular dilatation and dysfunction associated with asymmetry/dyssynchrony of the RV free wall (Figure 1, arrow heads), with two major criteria beingmet - a definitive diagnosis according to the revised 2010 Task Force criteria. The presence of concomitant left ventricular dysfunction and late enhancement