期刊
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
卷 27, 期 4, 页码 443-452出版社
WILEY-BLACKWELL
DOI: 10.1111/jce.12925
关键词
arrhythmogenic right ventricular; catheter ablation; dysplasia; cardiomyopathy; epicardial mapping; epsilon wave; right bundle branch block
资金
- Dr. Francis P. Chiaramonte Private Foundation
- St. Jude Medical Inc.
- Medtronic Inc
- Leyla Erkan Family Fund
- Dr. Satish, Rupal, and R. Shah ARVD Fund at Johns Hopkins
- Bogle Foundation
- Healing Hearts Foundation
- Campanella family
- P. J. Harrison Family
- Peter French Memorial Foundation
- Wilmerding Endowments
- Boston Scientific
- St. Jude Medical
EAM Correlates of Depolarization in ARVD BackgroundEpsilon waves and other depolarization abnormalities in the right precordial leads are thought to represent delayed activation of the right ventricular outflow tract in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However, no study has directly correlated cardiac electrical activation with the surface ECG findings in ARVD/C. Methods and ResultsThirty ARVD/C patients (mean age 32.7 11.2years, 16 men) underwent endocardial and epicardial electroanatomical activation mapping in sinus rhythm. Twelve-lead ECGs were classified into 5 patterns: (1) normal QRS (11 patients); (2) terminal activation delay (TAD) (3 patients); (3) incomplete right bundle branch block (IRBBB) (5 patients); (4) epsilon wave (5 patients); (5) complete right bundle branch block (CRBBB) (6 patients). Timing of local ventricular activation and extent of scar was then correlated with surface QRS. Earliest endocardial and epicardial RV activation occurred on the mid anteroseptal wall in all patients despite the CRBBB pattern on ECG. Total RV activation times increased from normal QRS to prolonged TAD, IRBBB, epsilon wave, and CRBBB, respectively (103.9 +/- 5.6, 116.3 +/- 6.5, 117.8 +/- 2.7, 146.4 +/- 16.3, and 154.3 +/- 6.3, respectively, P < 0.05). The total epicardial scar area (cm(2)) was similar among the different ECG patterns. Median endocardial scar burden was significantly higher in patients with epsilon waves even compared with patients with CRBBB (34.3 vs. 11.3 cm(2), P < 0.01). Timing of epsilon wave corresponded to activation of the subtricuspid region in all patients. ConclusionWe found that epsilon waves are often associated with severe conduction delay and extensive endocardial scarring in addition to epicardial disease. The timing of epsilon waves on surface ECG correlated with electrical activation of the sub-tricuspid region.
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