Left ventricular impairment of arrhythmogenic right ventricular dysplasia is a common feature. Angiographic left ventricular contraction abnormalities can be found in more than 20% of patients with arrhythmogenic right ventricular dysplasia. Left ventricular impairment appears at all functional and morphological stages of the disease, even in cases with only slight or moderate right ventricular dysfunction. An event of aborted sudden cardiac death with documented ventricular fibrillation can be found in 56% of patients with left ventricular impairment. Left ventricular abnormalities seem to be an independent risk factor of sudden cardiac death; this is particularly true in patients with cardiac arrest as the first manifestation of the disease.