A ■ ABSTRACTArrhythmogenic right ventricular cardiomyopathy (ARVC) is an increasingly recognized cause of ventricular tachycardia and sudden cardiac death in young people, notably young athletes. The best treatment is not clear, although options include antiarrhythmic drugs, radiofrequency ablation, and implantable defibrillators. ■ KEY POINTSThe classic presentation is of a young athlete who complains of palpitations and dizzy spells while exercising.The prevalence of ARVC is difficult to estimate, since many cases are only recognized postmortem. In one series, ARVC accounted for only 3% of cases of sudden death in young athletes, but reports from Italy put the figure at 20%. Electrocardiography, although not sensitive, is a useful initial test. Echocardiography is often the first test that demonstrates the characteristic abnormalities of ARVC, but a normal echocardiogram does not exclude the diagnosis.ARVC should be suspected if a family history of ARVC is present, if the patient or a family member has had an event of unexplained ventricular tachycardia or sudden cardiac death, if unexplained symptoms of presyncope, syncope, dyspnea, palpitations, or chest pain occur in a young adult, or if noninvasive tests such as ECG, Holter monitoring, or echocardiography reveal suggestive findings.Once the diagnosis of ARVC is made, the patient should refrain from participating in competitive sports or other intense exertional activities.

Postoperative atrial fibrillation (POAF) is common among surgical patients and associated with a worse outcome. Pathophysiology of POAF is not fully disclosed, and several perioperative factors could be involved. Direct cardiac stimulation from perioperative use of catecholamines or increased sympathetic outflow from volume loss/anaemia/pain may play a role. Metabolic alterations, such as hypo-/hyperglycaemia and electrolyte disturbances, may also contribute to POAF. Moreover, inflammation, both systemic and local, may play a role in its pathogenesis. Strategies to prevent POAF aim at reducing its incidence and ameliorate global outcome of surgical patients. Nonpharmacological prophylaxis includes an adequate control of postoperative pain, the use of thoracic epidural analgesia, optimization of perioperative oxygen delivery, and, possibly, modulation of surgery-associated inflammatory response with immunonutrition and antioxidants. Perioperative potassium and magnesium depletion should be corrected. The impact of those interventions on patients outcome needs to be further investigated.