Journal
HEART RHYTHM
Volume 6, Issue 6, Pages 769-775Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2009.02.031
Keywords
Right ventricular dysplasia; Electroanatomic mapping; Diagnosis
Categories
Funding
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [K23HL093350] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING [ZIAEB000065] Funding Source: NIH RePORTER
- Intramural NIH HHS [ZIA CL090019-01, ZIA EB000072-01] Funding Source: Medline
- NHLBI NIH HHS [K23 HL093350, K23HL093350, K23 HL093350-01] Funding Source: Medline
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BACKGROUND Parietal block, defined as intra right ventricular (RV) conduction slowing, is a major diagnostic criterion for arrhythmogenic right ventricutar dysplasia/cardiomyopathy (ARVD/C). OBJECTIVE We evaluated the utility of total RV endocardial activation duration (EAD) measured by 3-dimensional electroanatomic mapping during sinus rhythm in the diagnosis of ARVD/C. METHODS Twenty-five consecutive patients with frequent left bundle branch block morphology premature ventricutar complexes who underwent electroanatomic mapping as a part of the evaluation for ARVD/C were included in the study. All patients were evaluated using standard protocol that included electrocardiogram (ECG), signal-averaged ECG, Holter monitoring, echocardiography, and magnetic resonance imaging. Invasive testing was performed as indicated. Total RV EAD was measured as the time interval between the onset of RV activation to the Latest activated region in the RV. RESULTS The mean age of the study subjects was 38 +/- 11 years, and 32% were men. Fourteen subjects were diagnosed with ARVD/C using task force criteria, and the remainder had idiopathic ventricutar tachycardia. Although the surface QRS durations were similar, the total RV EAD was significantly prolonged in ARVD/C compared with idiopathic VT (83.9 +/- 10 ms vs. 50.8 +/- 7 ms, P < .001). None of the idiopathic VT subjects had RV EAD of >65 ms. RV EAD also showed significant negative correlation with RV ejection fraction. CONCLUSION Total RV EAD obtained by 3-dimensional electroanatomic mapping is a sensitive marker of intra-RV conduction delay in ARVD/C, and a total RV EAD of >65 ms accurately differentiates ARVD/C from idiopathic VT.
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