The new European Society of Cardiology guideline for the management of cardiomyopathies: key messages for cardiac electrophysiologists

Figures

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  Fig. 1. Characteristics of cardiomyopathies focusing on history of arrhythmias, electrocardiographic and electrophysiological findings with selected therapeutic options. Fx family history, ICD implantable cardioverter defibrillator, RBBB right bundle branch block, CRT cardiac resynchronization therapy, OAC oral anticoagulation, VEs ventricular extrasystoles, AAD antiarrhythmic drugs, VT/VF ventricular tachycardia/fibrillation

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  Fig. 2. Typical atrial flutter in a 69-year-old male with apical hypertrophic cardiomyopathy (septal thickness of 16 mm). Please note the electrocardiographic signs of left ventricular hypertrophy with high R waves going along with prominent negative T‑waves in V4–V6

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  Fig. 3. A 49-year-old male with biopsy-proven cardiac sarcoidosis. a Atypical right bundle branch block (RBBB) with prominent second component of the QRS complex in the presence of atrioventricular block I. b Sustained hemodynamically tolerated ventricular tachycardia (CL 430 ms). c–f Electro-anatomical CARTO activation map and bipolar right ventricular voltage map with extensive fibrosis that correlated with the cardiac magnetic resonance imaging illustrated by late gadolinium enhancement

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  Fig. 4. A 51-year-old male with genetically proven Anderson–Fabry disease and a history of aborted sudden cardiac death 4 years before presentation. After initial diagnosis of an assumed viral myocarditis, the patient presented 4 years later to the authors’ department with recurrent ventricular tachycardia (VT) (b). Late-stage Fabry disease with cardiac, neurological, and renal impairment was diagnosed. Cardiac magnetic resonance imaging (d,f) demonstrated apical and extensive posterolateral scarring that correlated to electroanatomical bipolar CARTO maps (c,e). The patient underwent endo- and epicardial VT ablation

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  Fig. 5. Electrocardiogram (a) of a 74-year-old male with wild-type ATTR amyloidosis initially presenting with a sustained ventricular tachycardia (b). Note the prominent diffuse late gadolinium enhancement on cardiac magnetic resonance imaging (c,d)

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  Fig. 6. A 21-year-old female competitive athlete who presented with a syncope while playing handball. The electrocardiogram (a) was already suspicious for arrhythmogenic right ventricular cardiomyopathy (right precordial negative T waves and VEs with superior and inferior axis). Please also note the unspecific signs of inferolateral early repolarisation. During programmed electrical stimulation, a sustained ventricular tachycardia (VT) with left bundle branch block inferior axis was inducible. Electroanatomic bipolar (color range 0.5–1.5 mV) (b) and unipolar (color range 5–8 mV) maps illustrate the predominately epicardial low voltage areas. The VT was successfully ablated from the endocardial anterior right ventricular outflow tract (c)

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  Fig. 7. Complete atrioventricular block (a) in a 40-year-old male with non-ischemic cardiomyopathy with mildly reduced left ventricular function but prominent intraseptal late gadolinium enhancement (b,c); the patient was found to have a likely pathogenic laminopathy (Lamin A/C) gene mutation. Marked P: sinus p waves and one P* atrial extrasystole in the ECG illustrate complete AV-dissociation in (a)