Letter to the Editor Right Ventricular Thrombosis in a Patient with Arrhythmogenic Right Ventricular Cardiomyopathy Precluding Intracardiac Defibrillator Implantation Initially

A 52-year-old man was admitted to a hospital with the chief complaint of palpitation. Electrocardiography revealed right ventricular outflow tract (RVOT) ventricular tachycardia, which was subsequently treated by direct-current shock after no responses to amiodarone infusion. Selective coronary angiography demonstrated a normal coronary artery. The patient was referred to our tertiary referral center for further evaluation. Electrocardiography demonstrated incomplete right bundle branch block, slurred S wave in the precordial lead, T-wave inversion in V1–V4 leads, and epsilon wave, especially in V2 (Figure 1). Transthoracic echocardiography demonstrated normal left ventricular size with global hypokinesia and moderate systolic dysfunction (ejection fraction=40%). The RVOT was dilated: its diameter in both parasternal long- and short-axis views was 43 mm (24 mm/ m2). The RV was also dilated with severe systolic dysfunction (fractional area shortening=20%), and the RV free wall was akinetic with aneurysm formation at the base of the RV free.....