Electrocardiographic Predictors of Electroanatomic Scar Size in Arrhythmogenic Right Ventricular Cardiomyopathy: Implications For Arrhythmic Risk Stratification

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ALESSANDRO ZORZI MD1,FEDERICO MIGLIORE MD, PHD1,MOHAMED ELMAGHAWRY MD1,2,MARIA SILVANO MD1,MARTINA PERAZZOLO MARRA MD, PHD1,ALICE NIERO MD1,KIM NGUYEN MD1,ILARIA RIGATO MD, PHD1,BARBARA BAUCE MD, PHD1,CRISTINA BASSO MD, PHD3,GAETANO THIENE MD3,SABINO ILICETO MD1,DOMENICO CORRADO MD, PHD

 

amplia-mente‘s insight:

      La Miocardiopatía arritmogénica del ventrículo derecho, también conocida como Displasia arritmogénica del ventrículo derecho, es una cardiopatía que cada vez se está viendo más como causa de muerte súbita entre sujetos jovenes y deportistas.

En el presenta artículo, se describen las alteraciones electrocardiográficas que se manifiestan en dicho cuadro patológico y que podrían utilizarse como predictivas para detectar a tiempo la presencia de este cuadro, sin que se llegue a la situación definitiva de la muerte súbita.

La patología forense debe servir entre otras muchas cosas para evitar futuras muertes.

Abstract

Introduction

The extent of right-ventricular (RV) electroanatomic scar (EAS) detected by endocardial voltage mapping (EVM) is a powerful invasive predictor of arrhythmic outcome in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Electrocardiogram (ECG) and signal-averaged ECG are noninvasive tools of established clinical value for the diagnosis of electrical abnormalities in ARVC. This study was designed to assess the role of ECG and SAECG abnormalities for noninvasive estimation of the extent and regional distribution of RV-EAS and prediction of scar-related arrhythmic risk.

Methods and Results

The study population included 49 consecutive patients [38 males, median age 35 years] with a definite diagnosis of ARVC and an abnormal EVM by CARTO system. At univariate analysis, the presence of epsilon waves, the degree of RV dilation, the severity of RV dysfunction and the extent of negative T-waves correlated with RV-EAS% area. Normal T-waves were associated with a median RV-EAS% area of 4.9% (4.5–6.4), negative T-waves in V1-V3 of 22.0% (8.5–30.6), negative T-waves in V1-V3 extending to lateral precordial leads (V4-V6) of 26.8% (11.5–35.2) and negative T-waves in both precordial (V2-V6) and inferior leads of 30.2% (24.8–33.0) (p<0.001). At multivariate analysis, the extent of negative T-waves remained the only independent predictor of RV-EAS% area (B = 4.4, 95%CI 1.3–7.4, p = 0.006) and correlated with the arrhythmic event-rate during follow-up (p = 0.03).

Conclusions

In patients with ARVC, the extent of negative T-waves across 12-lead ECG allows noninvasive estimation of the amount of RV-EAS and prediction of EAS-related arrhythmic risk.

See on onlinelibrary.wiley.com

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