Serial reevaluation of initially Task Force-negative patients presenting with LBBB VT and minor ECG abnormalities identified 12 additional patients (52%) meeting ARVD/C criteria at follow-up.
Cohort (n=60)
Does serial reevaluation identify delayed structural abnormalities fulfilling ARVD/C criteria in patients presenting with LBBB VT and minor ECG abnormalities?
Serial reevaluation is warranted in patients presenting with LBBB VT and minor ECG abnormalities, as structural changes fulfilling ARVD/C criteria may develop over time.
INTRODUCTION: Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is based on a set of criteria proposed by the International Task Force (TF) for Cardiomyopathies in 1994. To fulfill these criteria, presence of both electrocardiographic and anatomical abnormalities must be assessed with ECG and imaging techniques, respectively. This may be difficult in patients with early/mild forms of the disease as detectable structural abnormalities may still be absent. We evaluated in which patients presenting with right ventricular tachycardia (VT) serial reevaluation for ARVD/C is indicated. METHODS AND RESULTS: Sixty consecutive patients (41 men, mean age 40+/-15 years) were evaluated by the TF criteria for possible ARVD/C because of presentation with a left bundle branch block (LBBB) VT, representing 1 minor criterion. The presence on the ECG of a T-wave inversion beyond lead V2 (1 minor), right precordial QRS prolongation (1 major), or an epsilon wave (1 major) was assessed together with the visualization of severe regional/global right ventricle dysfunction (1 major) or mild segmental dilatation/regional hypokinesia (1 minor) by standard imaging techniques. Initially, 22 (37%) patients were diagnosed as having ARVD/C. After 47+/-39 (range 6-146) months, 23 initially TF-negative patients were reevaluated because of recurrent symptoms, with 12 (52%) additional patients now meeting the TF criteria. Eleven of these 12 (92%) patients presented initially with ECG abnormalities only, but developed structural abnormalities on imaging at follow-up. CONCLUSION: ECG abnormalities may precede structural abnormalities warranting serial reevaluation for ARVD/C in initially TF-negative patients presenting with LBBB VT with only ECG abnormalities.
Kiès et al. (Fri,) conducted a cohort in Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) (n=60). Serial reevaluation using ECG and imaging was evaluated on Fulfillment of Task Force criteria for ARVD/C at follow-up in initially TF-negative patients. Serial reevaluation of initially Task Force-negative patients presenting with LBBB VT and minor ECG abnormalities identified 12 additional patients (52%) meeting ARVD/C criteria at follow-up.