Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia
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Publication date
2023-03-30
Authors
Laredo, Mikael
Tovia-Brodie, Oholi
Milman, Anat
Michowitz, Yoav
Roudijk, Rob W.
Peretto, Giovanni
Badenco, Nicolas
te Riele, ASJM
Sala, Simone
Duthoit, Guillaume
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Article
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Abstract
Aims Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) and results sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available. Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants.
Keywords
Arrhythmogenic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, ECG, Site of origin, Ventricular arrhythmia, Cardiology and Cardiovascular Medicine, Physiology (medical), Journal Article
Citation
Laredo, M, Tovia-Brodie, O, Milman, A, Michowitz, Y, Roudijk, R W, Peretto, G, Badenco, N, Te Riele, A S J M, Sala, S, Duthoit, G, Arbelo, E, Ninni, S, Gasperetti, A, van Tintelen, J P, Paglino, G, Waintraub, X, Andorin, A, Peichl, P, Bosman, L P, Calo, L, Giustetto, C, Radinovic, A, Jorda, P, Casado-Arroyo, R, Zorio, E, Bermúdez-Jiménez, F J, Behr, E R, Havranek, S, Tfelt-Hansen, J, Sacher, F, Hermida, J-S, Nof, E, Casella, M, Kautzner, J, Lacroix, D, Brugada, J, Duru, F, Bella, P D, Gandjbakhch, E, Hauer, R & Belhassen, B 2023, 'Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia', Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, vol. 25, no. 3, pp. 1025-1034. https://doi.org/10.1093/europace/euac267