Abstract 4116: Electrocardiographic Markers of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: A reappraisal

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Rahul Jain ◽  
Darshan Dalal ◽  
Ariana Evenson ◽  
Rohit Jain ◽  
Amy Daly ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Sensitivity And Specificity ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Male Age ◽  
T Wave ◽  
Wave Inversion ◽  
Right Ventricular Dysplasia ◽  
Surface Ecg ◽  
Activation Delay ◽  
Sensitive Marker

Background: The Task Force criteria for diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) rely on depolarization and repolarization abnormalities detected on a surface ECG. Terminal activation delay (TAD) has recently been presented as specific and sensitive marker of ARVD/C. The purpose of this study was to evaluate the sensitivity and specificity of TAD in patients with ARVD/C. Methods : In a cohort of 74 patients with definite ARVD/C (51% male); age 36 ± 12 years) and 48 phenotypically normal non cardiac patients (35% male); age 35 ± 14 years) we studied the ECG criteria used to diagnose ARVD/C with specific a focus on TAD. The parameters analyzed were: T wave inversion (TWI) in ≥ V2, TWI ≥ V3, epsilon wave, QRS ≥ 110ms in V1 to V3, parietal block defined as QRSd V1–V6 or V2–V6 or V3–V6 >25 ms in the presence of QRS ≥ 100ms in at least 2 right precordial leads, TAD in V1-V3 and QRSd in V1+V2+V3/V4+V5+V6 ≥ 1.2. Sigma scan software was used for the ECG analysis. Results : In the ARVD/C group, the prevalence of TWI ≥ V2 was 82%, TWI ≥ V3 was 66%, epsilon wave: 1%, QRSd ≥ 110ms V1-V3: 39%, parietal block: 16%, TAD: 46 %, QRSd ratio ≥ 1.2: 19%. In the non cardiac group the prevalence of TWI ≥ V2 was 6 %, TWI ≥ V3: 6%, epsilon wave: 0%, QRSd ≥ 110ms V1–V3: 4%, parietal block: 2%, TAD: 12%, and QRSd ratio ≥ 1.2: 4% (Figure). Conclusion : The results of this study reveal that terminal activation delay has only moderate sensitivity and specificity for the diagnosis of ARVD/C. Our results also reveal that T wave inversion in the right precordial leads is a very sensitive marker of ARVD/C.

scholarly journals Global changes of ventricular repolarization in arrhythmogenic right ventricular dysplasia

2018 ◽  
Vol 5 (4) ◽  
pp. 35-43
Author(s):  
N. A. Arteyeva ◽  
I. A. Zemskov ◽  
T. A. Kurilenko ◽  
E. A. Parmon
Keyword(s):  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Ventricular Repolarization ◽  
Lateral Part ◽  
Ecg Changes ◽  
T Wave ◽  
Wave Inversion ◽  
Dispersion Of Repolarization ◽  
Right Ventricular Dysplasia ◽  
The Right

Background.In arrhythmogenic right ventricular dysplasia (ARVD), repolarization disorders precede structural heart changes.Objective.The aim of this work was to evaluate repolarization changes in ARVD patients with various degree of electrocardiographic (ECG) changes.Design and methods. The standard ECG and vectorcardiograms (VCG) of patients with a confirmed ARVD diagnosis (N = 22, 13 men 51 ± 16 years and 9 women 50 ± 12 years), observed in the Medical Centre of V.A. Almazov, were analyzed. The degree of ECG changes was assessed by the number of precordial leads with negative T-wave, the global dispersion of repolarization — on the basis of the maximum interval between the peak and the end of T-wave, the spatial repolarization sequence — by T-vector direction, the action potential duration (APD) — on the basis of Q-Tpeak and Q-Tend intervals.Results.At no T-wave inversion in precordial leads, the latest repolarization took place in the posterior regions of ventricular base, at T-wave inversion only in the right precordial leads — in the lateral part of the right ventricle, at T-wave inversion in all precordial leads — in the antero-apical parts of the ventricles. Depending on the degree of ECG changes, the duration of repolarization increased in such a way that the shorter APD increased more than the longer ones; the global dispersion of repolarization was not increased.Conclusion.In ARVD, the increase of repolarization ECG changes is a result of inhomogeneous APD prolongation and the changes in ventricular repolarization sequence (up to it’s inversion), not accompanied with a growth of global dispersion of repolarization.

Abstract 13804: Correlation between Electrocardiographic Features and Local Activation Pattern in Arrhythmogenic Right Ventricular Dysplasia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tanyanan Tanawuttiwat ◽  
Anneline S Te Riele ◽  
Binu Philips ◽  
Cynthia A James ◽  
Brittney Murray ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Anterior Wall ◽  
Activation Pattern ◽  
S Wave ◽  
Basal Angle ◽  
Right Ventricular Dysplasia ◽  
Surface Ecg ◽  
Qrs Duration ◽  
The Right

Background: Depolarization abnormalities in the terminal portion of the QRS are frequently seen in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C). The purpose of this study was to correlate the electroanatomic activation pattern of the RV endocardium and epicardium to the surface ECG. Methods: Thirty consecutive ARVD/C patients (Mean age 33.1 +/- 11.2 years, 16 (53%) men) underwent detailed endocardial and epicardial electroanatomical mapping (EAM). Local sinus rhythm activation was annotated at the sharpest intrinsic deflection of the bipolar electrogram, including late potentials. ECG features were classified into 5 major patterns; 1. Normal QRS (12 patients) 2. Epsilon wave (5 patients) 3. Incomplete RBBB (5 patients) 4. Atypical complete RBBB (6 patients) and 5. Prolonged terminal activation duration (TAD) (2 patients) Results: The earliest endocardial and epicardial RV activation occurred on the mid anteroseptal wall on all ECG patterns. Figure 1 represented activation area (purple) after the QRS or during the delayed depolarization phase. Nearly all endocardial and epicardial RV was activated well within the QRS duration in patients with normal QRS but was activated during R’ in patients with CRBBB. The delayed activation during Epsilon wave consistently occurred in basal anterior wall and basal angle of RV. In patients with TAD, the activation of RVOT and basal angle RV represented slurred S wave. Conclusion: ECG features in ARVD/C are correlated with late activation in specific regions of RV and total endocardial activation time. The delay activation of basal anterior wall and basal angle of RV represents the Epsilon wave in the right precordial ECG.

ACTIVATION DELAY IS ALREADY PRESENT IN THE EARLY CONCEALED STAGE OF ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA/CARDIOMYOPATHY

Heart Rhythm ◽  
2014 ◽  
Vol 11 (11) ◽  
pp. 2139-2140
Author(s):  
T.P. Mast ◽  
A.J. Teske ◽  
A.S. Te Riele ◽  
J.A. Groeneweg ◽  
J.F. van der Heijden ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Right Ventricular Dysplasia ◽  
Activation Delay

Abstract 1830: New ECG Criteria for Diagnosis of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Moniek G Cox ◽  
Arthur A Wilde ◽  
Ans C Wiesfeld ◽  
Richard N Hauer
Keyword(s):  
Right Ventricular ◽  
Dna Analysis ◽  
Task Force ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
List Type ◽  
S Wave ◽  
Right Ventricular Dysplasia ◽  
Genes Encoding ◽  
Criteria For Diagnosis ◽  
Activation Delay

Introduction Desmosomal changes, electrical uncoupling and surviving myocardial bundles embedded in fibrofatty tissue are hallmarks of activation delay (AD) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). AD is pivotal for reentrant mechanisms and thereby ventricular tachycardia (VT). At present, generally accepted Task Force Criteria (TFC) are used for clinical diagnosis of ARVD/C. We propose additional criteria (AC) on AD and VT to improve identification of affected individuals. Methods AD and VT-related electrocardiographic criteria were studied, while off drugs, in 42 patients with proven ARVD/C according to TFC, and 23 controls with idiopathic VT from the RV outflow tract. TFC assessed: epsilon waves, QRS width >110ms in V1–3 in absence of RBBB and negative T-waves in V2 and beyond. The 3 new AC are: prolonged S-wave upstroke in V1–3 (≥55ms from nadir of S to end of depolarization) occurrence of LBBB like VT with axis −30° to −150°and number of different monomorphic VT morphologies (different when Δ axis ≥30°; spontaneous and induced by programmed electrical stimulation (PES)). All ARVD/C patients were screened for mutations in genes encoding desmosomal proteins. Results For comparison of ARVD/C patients (pts) and controls: see table . In ARVD/C pts mean S-wave upstroke duration was 63±20 ms (range 40–140), mean number of different spontaneous VTs 1.8±0.95 (range 0–5) and mean number of spontaneous+induced VTs 2.8±1.08 (range 1–5). All VTs showed LBBB morphology. Plakophilin-2 mutations were identified in 25 (60%) of ARVD/C pts. Parameters measured were not significantly different between mutation carriers and non-carriers. Conclusions The newly proposed criteria are sensitive and specific for ARVD/C and thereby useful for its diagnosis, independent of outcome of DNA analysis. Prolonged S-wave upstroke is the most sensitive ECG indicator of activation delay during sinus rhythm. PES contributes to yield of VT morphologies.

scholarly journals The Application of Holter ECG-Based T-Wave Alternans in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

2011 ◽  
Vol 27 (Supplement) ◽  
pp. OP68_3
Author(s):  
Fa-Po Chung ◽  
Yenn-Jiang Lin ◽  
Cheng-Hung Li ◽  
Shih-Lin Chang ◽  
Li-Wei Lo ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Holter Ecg ◽  
T Wave ◽  
Right Ventricular Dysplasia ◽  
T Wave Alternans

scholarly journals Long Term Follow-Up in a Patient with Arrhythmogenic Right Ventricular Dysplasia

2021 ◽  
Vol 31 (2) ◽  
pp. 379-383
Author(s):  
Diana-Aurora BORDEJEVIC ◽  
Cristina VACARESCU ◽  
Simina CRISAN ◽  
Lucian PETRESCU ◽  
Tudor Luca CONSTANTIN ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Fatty Infiltration ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Resonance Imaging ◽  
T Wave ◽  
Right Ventricular Dysplasia ◽  
Long Term Follow Up ◽  
The Right

This case report describes eight years of follow-up in a young adult with arrhythmogenic right ventricular dysplasia (ARVD). He presented with exertional palpitations, symmetric T wave inversions and possible epsilon waves in the right precordial leads on electrocardiogram (EKG), raising suspicion for ARVD. Transthoracic echocardiography revealed a dilated and excessively trabeculated right ventricle (RV), and cardiac magnetic resonance imaging showed fatty infiltration of the RV myocardium. These findings established the diagnosis of ARVD, and given his palpitations, a defibrillator was implanted. Over the next years, he had several episodes of ventricular tachycardia requiring therapy from his device, despite escalating medical therapy. He therefore underwent radiofrequency catheter ablation for the VT, which successfully controlled the VT.

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