Transvenous implantable cardioverter-defibrillator implantation in a patient with arrhythmogenic cardiomyopathy and massive right atrial thrombus

Arrhythmogenic cardiomyopathy (ACM) is an inherited myocardial disease that is characterized by a progressive loss of myocytes with fibrofatty replacement and predisposes to ventricular tachycardia (VT) and sudden cardiac death.1 Implantable cardioverter-defibrillators (ICDs) are indicated for VT; however, the use of those devices is often challenging because of sensing dysfunction with a low right ventricular sensing amplitude and dilated right atrium (RA). Atrial arrhythmias are common in ACM and are associated with inappropriate ICD shocks and an increased risk of both death and heart failure.