Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6289-6297
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6289
Dilated left ventricle with multiple outpouchings — a severe congenital ventricular diverticulum or left-dominant arrhythmogenic cardiomyopathy: A case report
Xin Zhang, Run-Yu Ye, Xiao-Ping Chen
Xin Zhang, Run-Yu Ye, Xiao-Ping Chen, Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang X and Ye RY contributed equally to this article; Zhang X and Ye RY were the patient’s cardiologists, reviewed the literature, and contributed to manuscript drafting; Chen XP was responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Supported by Chengdu Science and Technology Bureau, China, No. 2020-YF05-00290-SN.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and the accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiao-Ping Chen, MD, Chief Doctor, Cardiology Department, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China.
Received: December 26, 2021
Peer-review started: December 26, 2021
First decision: March 7, 2022
Revised: March 20, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: June 26, 2022

Left-dominant arrhythmogenic cardiomyopathy (LDAC) is a relatively rare disease characterized by poor prognosis that exacerbates the incidence of sudden cardiac death and ventricular arrhythmias. Clinically, LDAC is constantly overlooked or misdiagnosed as myocardial infarction, myocarditis, and dilated cardiomyopathy, owing to atypical and nonspecific clinical manifestations at an early stage.


A 57-year-old woman was diagnosed with sinus bradycardia and chronic bifascicular block during a health check. She occasionally experienced mild chest pain and paroxysmal palpitation during activity in the past 2 years. Comprehensive auxiliary examinations, including electrocardiogram, echocardiography, coronary computerized tomography angiography, and magnetic resonance imaging, revealed that she had LDAC instead of congenital ventricular diverticulum. The physicians prescribed standard oral therapy for heart failure and implantable cardioverter-defibrillator. Consequently, her left ventricular systolic function and symptoms remained stable at the 2-year follow-up after discharge.


Based on this case, clinicians need to be aware of LDAC in patients with localized left ventricular lesions and multiple electrocardiographic abnormalities. Multimodality cardiovascular imaging is effective in identification of multiple types of cardiomyopathy and cardiac inner structures.

Keywords: Congenital ventricular diverticulum, Left-dominant arrhythmogenic cardiomyopathy, Magnetic resonance imaging, Case report

Core Tip: Left-dominant arrhythmogenic cardiomyopathy is a relatively rare disease, characterized by poor prognosis. We present a case with a dilated left ventricle that manifested with reduced ejection fraction, multiple outpouchings, left chest leads low voltage, and fragmented QRS. Multimodality cardiovascular imaging diagnosed the patient with left-dominant arrhythmogenic cardiomyopathy instead of congenital ventricular diverticulum. This case alerts clinicians to be aware of left-dominant arrhythmogenic cardiomyopathy in patients with localized left ventricular lesions and multiple electrocardiographic abnormalities.