{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:11:46Z","timestamp":1788873106274,"version":"build-2803163510"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Arrhythmogenic cardiomyopathy (ACM) is a genetic myocardial disease classically characterized by ventricular arrhythmias and right ventricular involvement. Biventricular variants involving PKP2 mutations are increasingly recognized but rarely present primarily as severe heart failure and multi-focal thromboembolism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 22-year-old woman presented with progressive exertional dyspnoea and severe biventricular dysfunction [left ventricular systolic dysfunction (LVEF) 20%]. The clinical course was complicated by right subclavian vein thrombosis and an acute cerebellar infarction. Cardiac magnetic resonance imaging demonstrated biventricular involvement with a non-ischaemic pattern of myocardial fibrosis. Genetic testing identified a pathogenic heterozygous PKP2 variant, which, integrated with the phenotype, established the diagnosis of ACM. Serial electrocardiographic assessment revealed a high burden of multifocal premature ventricular complexes, which persisted despite catheter ablation and increased during ambulation, indicating ongoing electrical instability. The patient received optimized guideline-directed medical therapy and rivaroxaban. At follow-up, she demonstrated reverse remodelling with an improved LVEF of 31%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case expands the clinical spectrum of PKP2-associated ACM, emphasizing that severe heart failure and thromboembolism can dominate the clinically apparent presentation. While significant arrhythmias, including non-sustained ventricular tachycardia and a high premature ventricular contraction (PVC) burden, are classic hallmarks of the disease, in this case, they did not prompt initial medical attention and were instead documented on later surveillance. Although electrical remodelling occurs early, it may remain clinically concealed until unmasked by progressive structural damage. Early integration of multimodality imaging and genetic testing is essential for accurate diagnosis and risk stratification. Implantable cardioverter-defibrillator implantation was planned for primary prevention of sudden cardiac death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag636","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:44:01Z","timestamp":1787827441000},"source":"Crossref","is-referenced-by-count":0,"title":["Biventricular arrhythmogenic cardiomyopathy due to a\n                    <i>PKP2<\/i>\n                    mutation with severe heart failure and multifocal thromboembolism as the clinically apparent presentation: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1428-9206","authenticated-orcid":false,"given":"Binh Thi Thanh","family":"Dao","sequence":"first","affiliation":[{"name":"Faculty of Medicine, HUTECH University, 475A Dien Bien Phu Street, Thanh My Tay Ward, Ho Chi Minh City 72331 ,","place":["Vietnam"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thong Minh","family":"Chau","sequence":"additional","affiliation":[{"name":"Department of Cardiology, 115 People's Hospital, 527 Su Van Hanh Street, Hoa Hung Ward, Ho Chi Minh City 72523 ,","place":["Vietnam"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"2026090808574332500_ytag636-B1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1056\/NEJMra1509267","article-title":"Arrhythmogenic right ventricular cardiomyopathy. Jarcho JA, ed","volume":"376","author":"Corrado","year":"2017","journal-title":"N Engl J Med"},{"key":"2026090808574332500_ytag636-B2","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijcard.2020.06.005","article-title":"Diagnosis of arrhythmogenic cardiomyopathy: the Padua criteria","volume":"319","author":"Corrado","year":"2020","journal-title":"Int J Cardiol"},{"key":"2026090808574332500_ytag636-B3","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.1016\/j.hrthm.2019.05.007","article-title":"2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy","volume":"16","author":"Towbin","year":"2019","journal-title":"Heart Rhythm"},{"key":"2026090808574332500_ytag636-B4","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1146\/annurev.med.052208.130419","article-title":"Arrhythmogenic cardiomyopathy: etiology, diagnosis, and treatment","volume":"61","author":"Sen-Chowdhry","year":"2010","journal-title":"Annu Rev Med"},{"key":"2026090808574332500_ytag636-B5","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1161\/CIRCRESAHA.110.223412","article-title":"The cardiac desmosome and arrhythmogenic cardiomyopathies: from gene to disease","volume":"107","author":"Delmar","year":"2010","journal-title":"Circ Res"},{"key":"2026090808574332500_ytag636-B6","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1093\/eurjhf\/hfs073","article-title":"Thrombo-embolism and antithrombotic therapy for heart failure in Sinus rhythm. A joint consensus document from the ESC heart failure association and the ESC working group on thrombosis","volume":"14","author":"Lip","year":"2012","journal-title":"Eur J Heart Fail"},{"key":"2026090808574332500_ytag636-B7","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur Heart J"},{"key":"2026090808574332500_ytag636-B8","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag636\/70818172\/ytag636.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/9\/ytag636\/70818172\/ytag636.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/9\/ytag636\/70818172\/ytag636.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:57:53Z","timestamp":1788872273000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag636\/8771712"}},"subtitle":[],"editor":[{"given":"Valentina","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Ikram","family":"Haq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Gregorio","family":"Tersalvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":8,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,8,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag636","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,27]]},"article-number":"ytag636"}}