Electrocardiographic Repolarization Abnormalities and Electroanatomic Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy. (March 2018)

• Record Type: Journal Article
• Authors: Kubala, Maciej; Pathak, Rajeev K.; Xie, Shuanglun; Casado Arroyo, Ruben; Tschabrunn, Cory M.; Hayashi, Tatsuya; Garcia, Fermin C.; Supple, Gregory E.; Santangeli, Pasquale; Frankel, David S.; Zado, Erica S.; Callans, David J.; Marchlinski, Francis E.
• Is Part Of: Circulation. Volume 11:Number 3(2018)
• Publication Date: 2018-03
• Subjects: cardiomyopathy -- catheter ablation -- electrocardiography -- endocardium -- tachycardia, ventricular; Arrhythmia -- Periodicals; Heart -- Electric properties -- Periodicals; 616.128
• DOI: 10.1161/CIRCEP.117.005553
• Languages: English
• ISSNs: 1941-3149

Abstract

Abstract : Background: Repolarization abnormalities in arrhythmogenic right ventricular (RV) cardiomyopathy and their relationship to ventricular tachycardia substrate are incompletely understood. Methods and Results: In 40 patients (29 men, mean age 38 years) with arrhythmogenic RV cardiomyopathy, we compared the extent and location of abnormal T (NegT) waves ≥1 mm in depth (n=32) and downsloping elevated ST segment (n=13), in ≥2 adjacent leads, to area and location of endocardial bipolar (<1.5 mV) and unipolar (<5.5 mV) and epicardial bipolar (<1.0 mV) voltage abnormalities. Abnormal unipolar RV endocardial area of 33.4±19.3% was present in 8 patients without NegT waves. Patients with NegT waves extending beyond lead V3 (n=20) had larger low bipolar (31.4±18.9% versus 16.5±14.6%; P =0.008) and unipolar endocardial areas (66.0±19.6% versus 47.4±25.1%; P =0.013) and larger epicardial low bipolar area (56.0±19.3% versus 40.1±24.9%; P =0.030) compared with those with NegT waves limited to leads V1 through V3 (n=20). ECG location of NegT waves regionalized to location of substrate. Patients with downsloping elevated ST segment, all localized to leads V1 and V2, had more unipolar endocardial abnormalities (71.8±18.1% versus 49.4±23.5%; P =0.005) involving outflow and mid-RV, compared with patients without downsloping elevated ST segment. Conclusions: In arrhythmogenic RV cardiomyopathy, abnormal electroanatomic mapping areas are proportional to extent of T-wave inversion on 12-lead ECG. Marked voltage abnormalities can exist without repolarization change. Downsloping elevated ST-segment pattern in V1 and V2 occurs with more unipolar endocardial voltage abnormality, consistent with more advanced transmural disease.