Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
Sustained VT, resuscitated arrest, arrhythmic syncope or acute myocardial-injury 'hot phase' with instability requires monitored emergency care and inherited-cardiac/electrophysiology input.
Synopsis
Recognise arrhythmogenic cardiomyopathy, integrate electrical, imaging and genetic evidence, and reduce exercise-related and sudden-death risk.
ARVC is a genetic arrhythmogenic cardiomyopathy with fibrofatty myocardial replacement; biventricular and left-dominant disease occur.
Diagnosis is multiparametric: no single ECG, echo, CMR or genetic finding is sufficient in isolation.
Clues include T-wave inversion V1-V3 beyond the expected age, terminal activation abnormalities and VT with left-bundle morphology.
Key red flags
Hot phase
Chest pain and troponin rise with non-ischaemic scar, recurrent 'myocarditis' or a DSP family history should raise arrhythmogenic cardiomyopathy.
Investigation priorities
01
12-lead and signal-averaged ECGFirst step
Identify repolarisation/depolarisation criteria and conduction alternatives.
Management branches
DiagnosisSuspected ARVC
Arrhythmic symptoms, suggestive ECG/CMR or family diagnosis.
Stop competitive/high-intensity exercise pending assessment; obtain a three-generation pedigree and details of sudden deaths or recurrent myocarditis.
Perform ECG, ambulatory monitoring, expert TTE and CMR with quantitative biventricular assessment.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.