If you hear that a strong middle-aged or young friend suddenly collapsed and died, you must be wondering what was wrong with him. Unfortunately, the cause of death of these people is often impossible to figure out because the vast majority of Chinese people are influenced by traditional concepts and are not willing to undergo pathological autopsy. However, according to foreign data, about half of these young and middle-aged men who are usually healthy but die suddenly die from a single disease: ventricular tachycardia (ventricular tachycardia) or ventricular fibrillation (ventricular fibrillation) caused by arrhythmogenic right ventricular cardiomyopathy (ARVC). Yao Yan, Department of Cardiovascular Medicine, Fu Wai Hospital, Beijing, was first identified by Dr. Fontaine in France in 1978. It was first thought to be due to congenital dysplasia of the right ventricular myocardium, but later in 1994, the World Health Organization (WHO) commissioned an international expert group to conduct an in-depth study of the disease, which confirmed that the disease developed gradually and worsened later in life and should be classified as cardiomyopathy rather than a congenital dysplasia. However, to this day, a significant number of physicians still refer to it as right ventricular dysplasia (ARVD) due to a lack of adequate knowledge of the disease. Why is the difference in name emphasized? Because, if the dysplasia is congenital, it means that there is nothing doctors can do about it, but if it is progressive, although there is also a congenital genetic defect, it is still possible to mitigate or slow down the progression of the disease as much as possible with some measures. In fact, it has been found that the disease is caused by defects in some genes related to cell bridging grains, but acquired physical labor, stress, and physical exercise can accelerate and aggravate the development of the disease, and therefore, the incidence of the disease is significantly higher in men than in women in the population, and people who love sports (especially athletes) or those who are engaged in heavy physical labor for a long time are more likely to develop the disease. The time of first onset also varies from person to person, with most attacks occurring between the ages of 20 and 40, but also in children and the elderly. The incidence of the disease ranges from 2 to 44 per 100,000. The reason for this wide variation is mainly a reflection of the level of awareness of the disease among physicians in different regions, which means that a lack of understanding of the disease by physicians can easily lead to misdiagnosis or underdiagnosis, especially for patients in the early and middle stages. Studies have shown that sudden death may occur in roughly 20% of patients with ARVC. The disease is currently diagnosed by ultrasound, MRI, electrocardiogram, right ventriculography, and myocardial biopsy. The diagnosis is relatively easy in patients with typical advanced disease, but early and mid-stage patients are often missed because the right ventricular lesions are not severe. We would like to remind all patients that if you have a sudden onset of rapid heartbeat or even fainting, you should call the emergency number at the onset or go to the hospital emergency room as soon as possible and try to get an ECG traced at the onset, which is crucial to determine if it is ARVC ventricular tachycardia. If your doctor tells you that it is a right ventricular non-outflow tract ventricular tachycardia (some doctors will call it right ventricular inflow tract ventricular tachycardia), then it is likely that you have ARVC ventricular tachycardia. Of course, some patients with ARVC may also have outflow tract ventricular tachycardia. In addition, it is worth pointing out that although the disease is called arrhythmogenic cardiomyopathy, not all patients get ventricular tachycardia, and a significant number only have premature ventricular beats, especially in the early stages. For example, in the case of ventricular tachycardia with the same 200 beats per minute, if the lesion involves only the right ventricle, the patient can often tolerate it for a longer period of time and get to the hospital in time for resuscitation or treatment, but if it is combined with a left ventricular lesion, the patient is more likely to faint or even die because of the hypotension caused. In terms of treatment, right ventricular cardiomyopathy has two main effects. One is to cause ventricular tachycardia and ventricular fibrillation, which manifest as panic, fainting and even death, which are the most important symptoms of this disease. The second is to cause right heart insufficiency, which is both rare and generally less severe in terms of symptoms. Therefore, the first clinical treatment is to prevent death due to ventricular tachycardia or ventricular fibrillation. A more reliable treatment for patients with a rapid heart rate during ventricular tachycardia or who have ever fainted is the installation of an automatic defibrillator (ICD), which does not cure the disease itself, but allows for electrical defibrillation to save the patient’s life in the event of malignant ventricular tachycardia or ventricular fibrillation. Unfortunately, this therapy is costly, typically requiring $100,000 to $200,000 for a single installation, and lasts approximately 5-7 years after each installation. Many young patients cannot afford it financially, and some are concerned about social discrimination in education, employment and marriage after installation. On the other hand, ICD installation does not necessarily guarantee safety, and ICDs themselves can bring some complications and side effects. Therefore, some scholars have tried to use catheter ablation to treat this disease. Although it is theoretically possible to eliminate the ventricular tachycardia lesion in ARVC, it is difficult to do so in practice. The main problem is that it is still in the fumbling stage and lacks an accepted and long-tested procedure. The procedure itself is risky, as the right ventricle itself is already fragile due to lesions, and the procedure may lead to cardiac rupture and death. In addition, it is difficult to find all the lesions in one operation, or if they are found but are too many and too deep to be completely eliminated in one operation, it is possible that 2 or even more operations may be required. There is also the possibility that the lesions continue to develop after surgery and new ventricular tachycardia develops. Despite these difficulties, the fact that this disease is one of the most clinically dangerous heart diseases and that patients are often young and are important breadwinners in their families, has motivated some doctors to study it. Currently, ablation of ventricular tachycardia is carried out in a few hospitals in the United States, Europe and Japan, and the largest number of cases is only about 30, but Yao Yan’s team at Fu Wai Hospital is more than ten times ahead of other hospitals. After more than 10 years of painstaking research, we have developed a complete set of unique strategies for ARVC ventricular tachycardia detection and ablation, and have not only completed the largest series of cases in the world (nearly 300 cases), but also achieved the highest success rate in the world. With an average of less than 1.3 procedures, more than 80% of the patients were free of morbidity during the follow-up period (as short as 1 year and as long as 10 years), and the remaining patients showed significant improvement, i.e., significantly less morbidity and significantly better results with medication. In contrast, the success rate in other internationally renowned hospitals is generally less than 50%, with the lowest being only 15%. It is worth pointing out that since patients in developed countries are often fitted with ICDs, even if the ablation procedure is unsuccessful, the safety of the patient is relatively guaranteed. Although we have been carrying out this work for 10 years, we cannot say that we have completely conquered this disease in a scientific manner, and we need more long-term research and observation before we can make a definite conclusion. Therefore, after surgery, patients are still advised to: 1) continue taking Betaloc + cardioplegia, or sotalol; 2) take vasodilators, ACEI or even diuretics if necessary; 3) avoid heavy physical labor and physical exercise as much as possible, and adjust their psychological state to avoid mental stimulation such as excessive stress, in order to slow down the development of the disease; 4) review regularly (echocardiogram, electrocardiogram), usually at least once a year once.