IJCS | Volume 31, Nº6, November / December 2018

670 Cont. chart 1 - Revised 2010 Task Force Criteria for the Diagnosis of Arrhythmogenic Right Ventricular Dysplasia/ Cardiomyopathy (ARVD) 4. Conduction/depolarization alterations Major - Epsilon wave in leads V1 to V3 Minor - Duration of QRS terminal activation ≥ 55 ms measured from the S wave nadir to the end of QRS, including R’ at V1, V2, V3 in the absence of complete RBBB of the His bundle - High-resolution ECG late potentials in more than one of the following three parameters in the absence of QRS ≥ 110 ms on the standard 12-lead ECG: - Duration of filtered QRS (fQRS) ≥ 114 ms - QRS terminal duration < 40 μV (low amplitude signal duration) ≥ 38 ms - Root mean square of the potential in the 40 ms terminals of ventricular activation (MRIS40 - mV) ≤ 20 μV 5. Arrythmias Major - Sustained or non-sustained ventricular tachycardia with complete LBBB morphology with superior axis (QRS negative or undetermined in II, III, aVF and positive in aVL) Minor - Sustained or non-sustained ventricular tachycardia with right ventricular outflow tract configuration, complete LBBB morphology with inferior axis (QRS positive in II, III and aVF and negative in aVL) or of indeterminate axis - > 500 ventricular extrasystoles in the 24-hr Holter monitoring 6. Family history Major - Confirmed ARVD in a first-degree relative meeting the Task Force criteria - ARVD confirmed by histopathology at the autopsy or surgery in first-degree relative - Identification of pathogenic mutation categorized as associated or likely to be associated with ARVD* in a patient undergoing evaluation Minor - History of ARVD in a first-degree relative in whom it is not possible or the feasibility of confirming the presence of Task Force criteria is difficult - Sudden cardiac death (age < 35 years) due to suspected ARVD in first-degree relative - ARVD confirmed by histopathology or according to the current Task Force criteria in second-degree relative * A pathogenic mutation is understood as a DNA change associated with ARVD, which alters or is expected to alter a coded protein, not being observed or being rare in a control population without ARVD, and which alters or is predicted to alter the protein function or structure, or that has shown an association with the phenotype of the pathology in a family tree. RVOT: right ventricular outflow tract; PLAX: parasternal long axis; MRI: magnetic resonance imaging; BSA: body surface area; PSAX: parasternal short axis; RBBB: right bundle branch block; ECG: electrocardiogram; LBBB: left bundle branch block. Source: adapted from Marcus et al. 5 Augusto et al. Biventricular arrhythmogenic cardiomyopathy Int J Cardiovasc Sci. 2018;31(6)667-671 Case Report not restricted to the RV (Figure 1, arrows) is a finding compatible with biventricular involvement in the context of this cardiomyopathy. It is important to emphasize that these diagnostic criteria refer to the ARVD, with or without LV involvement. However, LV involvement has been increasingly described, because of the development of several complementary diagnostic means, such as the cardiac MRI. 7 It is worth mentioning that, in some series, biventricular involvement reaches 70%. 5 This case is noteworthy not only for the presence of biventricular dilatation and dysfunction, but also for the obvious presence of late enhancement with a non- ischemic pattern in both ventricles; this last finding has a sensitivity of 66% and a specificity of 100% for the diagnosis of this entity. 8 Particularly relevant is the use of the late enhancement criterion for the supposed evaluation of the LV involvement extent in some published series and case reports, when it does not integrate the current Task Force diagnostic items. 9 In fact,