March 26, 2008Journal of Cardiovascular Electrophysiology
Activation Delay and VT Parameters in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Toward Improvement of Diagnostic ECG Criteria
Key result
Proposed additional ECG criteria, such as prolonged terminal activation duration, were met in up to 88% of ARVD/C patients compared to 3.7% of controls with idiopathic VT (P<0.001).
Why the study?
Do additional ECG criteria based on activation delay and VT parameters improve the diagnosis of ARVD/C compared to current task force criteria?
Population
42 patients with proven arrhythmogenic right ventricular dysplasia/cardiomyopathy according to task force…
Comparison
Proposed additional ECG criteria vs Current generally accepted task force criteria
Design
Case-control
Authors
Discussion
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Implication
May aid ARVD/C diagnosis in selected cases; hypothesis-generating and requires prospective validation before task force adoption.
Key Points
- To improve the diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) using additional ECG criteria.
- Examined activation delay and VT-related 12-lead ECG criteria in 42 ARVD/C patients and 27 control patients with idiopathic VT.
- Proposed new ECG criteria for ARVD/C diagnosis based on activation delay and VT characteristics.
- Conducted electrophysiologic studies to explore different VT morphologies.
- Proposed criteria were met significantly more in ARVD/C patients: 71% for prolonged terminal activation duration, 67% for VT with LBBB morphology, and 88% for multiple VT morphologies.
- Pathogenic plakophilin-2 mutations found in 60% of ARVD/C patients, none in controls.
- Negative T waves in V1-3 were more frequent in mutation carriers compared to noncarriers.
Study Design
Type
Case-Control (n=69)
Structured PICO
Do additional ECG criteria based on activation delay and VT parameters improve the diagnosis of ARVD/C compared to current task force criteria?
P
Population
42 patients with proven arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) according to task force criteria, and 27 controls with idiopathic ventricular tachycardia from the right ventricular outflow tract.
I
Intervention
Proposed additional ECG criteria (prolonged terminal activation duration, VT with LBBB morphology and superior axis, and multiple different VT morphologies)
C
Comparator
Current generally accepted task force criteria (TFC)
O
Outcome
Diagnostic sensitivity and specificity for ARVD/Csurrogate
Main Result
Absolute Event Rate: 71% vs 3.7%
p-value: p=< 0.001
Adding ECG criteria based on activation delay and VT parameters to current task force criteria improves the diagnostic sensitivity for ARVD/C independent of DNA analysis.
Cite This Study
Cox et al. (2008) conducted a case-control in Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) (n=69). Proposed additional ECG criteria vs. Controls with idiopathic VT was evaluated on Prolonged terminal activation duration (p=< 0.001). Proposed additional ECG criteria, such as prolonged terminal activation duration, were met in up to 88% of ARVD/C patients compared to 3.7% of controls with idiopathic VT (P<0.001).