case_images: PMC11810138_01
case_images: Electrocardiogram at rest of case 1 at the age of 16 years (i.e., three years from diagnosis). A) Negative T waves from V1 to V5 (triangles) and multifocal premature ventricular contractions (bold arrows); B) Sinus bradycardia with a heart rate of 44 beats per minute and junctional rhythm
case_images: cureus-0017-00000077253-i01.jpg
case_images: PMC11810138_01_cureus-0017-00000077253-i01.jpg
case_images: FIG1
case_images: The electrocardiogram showed bradycardia and premature ventricular contractions (PVCs) with the right bundle branch block (Figure 1).
case_images: Cardiac magnetic resonance imaging of case 1 at diagnosis. T1-weighted magnetic resonance imaging showing fatty replacement of the myocardium of the right ventricle (bold arrow)
case_images: cureus-0017-00000077253-i02.jpg
case_images: PMC11810138_01_cureus-0017-00000077253-i02.jpg
case_images: FIG2
case_images: Therefore, cardiac magnetic resonance imaging (MRI) was performed, and fatty tissue replacement of the cardiomyocytes was found at the lateral RV on late gadolinium enhancement and T1-weighted image (Figure 2).
case_images: PMC11810138_02
case_images: Electrocardiogram at rest of case 2 at diagnosis. 12-lead electrocardiogram showing bradycardia, premature ventricular contractions (PVCs) (bold arrows), and low voltage in all leads
case_images: cureus-0017-00000077253-i03.jpg
case_images: PMC11810138_02_cureus-0017-00000077253-i03.jpg
case_images: FIG3
case_images: The electrocardiogram showed bradycardia, PVCs, and low voltage both in precordial leads and in limb leads (Figure 3).
case_images: Cardiac magnetic resonance imaging of case 2 at diagnosis. Left ventricular ejection fraction, 38%; cardiac index, 1.2 L/min/m2. A) Late gadolinium enhancement image showing fibrosis and fatty replacement of the myocardium of the right ventricle (RV) with intense signal at the anterior wall and apex (bold arrows). The area pointed to by a triangle shows thinning of the myocardium of the RV; B) Late gadolinium enhancement image showing fibrosis and fatty infiltration of the myocardium also in the area including the apex and the interventricular septum (bold arrow); C) Sequence of gradient echo cine showing thinning of the myocardium of the area including the posterior wall (bold arrow) and apex (triangle) of the left ventricle. Aneurysm formation is also seen at the apex of the left ventricle (triangle).
case_images: cureus-0017-00000077253-i04.jpg
case_images: PMC11810138_02_cureus-0017-00000077253-i04.jpg
case_images: FIG4
case_images: We suspected cardiomyopathy and performed a cardiac MRI, and we found diffuse late gadolinium enhancement, sporadic thinning of the cardiac muscle (Figure 4), and biventricular dysfunction.
case_images: PMC11810138_03
case_images: Electrocardiogram of case 3 at rest at the age of 13 years. A) Bigeminal premature ventricular contractions (PVCs) (bold arrows); B) Multifocal premature ventricular contractions and non-sustained ventricular tachycardias (triangles)
case_images: cureus-0017-00000077253-i05.jpg
case_images: PMC11810138_03_cureus-0017-00000077253-i05.jpg
case_images: FIG5
case_images: An 18-year-old boy was found to have asymptomatic bigeminal PVCs during a heart disease screening in school at the age of 12 years (Figure 5A). NSVTs (in triplets, with a maximum rate of 182 bpm) even at rest (Figure 5B). No genetic testing has been performed according to the patient's and the family's wishes.
case_images: Cardiac magnetic resonance imaging of case 3 at diagnosis. T1-weighted magnetic resonance imaging showing fat deposit from anterolateral to the apical wall of the left ventricle
case_images: cureus-0017-00000077253-i06.jpg
case_images: PMC11810138_03_cureus-0017-00000077253-i06.jpg
case_images: FIG6
case_images: MRI findings of fat replacement of the myocardium on the LV apex (Figure 6). Moreover, he had multifocal PVCs and