Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia
Key result
Three-dimensional electroanatomic voltage mapping enhanced ARVC/D diagnostic accuracy by identifying low-voltage areas associated with fibrofatty myocardial replacement (P<0.0001).
Why the study?
Does three-dimensional electroanatomic voltage mapping increase the accuracy of diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia in patients fulfilling noninvasive diagnostic criteria?
Population
31 consecutive patients who fulfilled the criteria of the Task Force of the European Society of Cardiology…
Design
Cohort
Authors
Discussion
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Implication
May aid ARVC/D differentiation in selected patients; hypothesis-generating and requires prospective validation before practice change.
Key Points
- The aim is to evaluate the effectiveness of three-dimensional electroanatomic voltage mapping in diagnosing arrhythmogenic right ventricular cardiomyopathy/dysplasia.
- Thirty-one patients underwent electroanatomic voltage mapping and endomyocardial biopsy for diagnosis validation.
- Electrogram samples from the right ventricle were collected during sinus rhythm.
- Comparison of low-voltage electrogram findings with echocardiographic and histopathological data.
- 20 patients (65%) had low-voltage areas indicating significant myocardial loss; associated with worse arrhythmic outcomes (P=0.02).
- Low-voltage areas correlated with fibrofatty replacement at biopsy (P<0.0001).
- 11 patients (35%) had preserved voltages and related inflammatory cardiomyopathy, suggesting alternative diagnoses.
Study Design
Type
Observational (n=31)
Structured PICO
Does three-dimensional electroanatomic voltage mapping increase the accuracy of diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia in patients fulfilling noninvasive diagnostic criteria?
P
Population
31 consecutive patients (22 men and 9 women; mean age, 30.8+/-7 years) who fulfilled the criteria of the Task Force of the European Society of Cardiology and International Society and Federation of Cardiology (ESC/ISFC) for ARVC/D diagnosis after noninvasive clinical evaluation
I
Intervention
Invasive study including right ventricular (RV) three-dimensional electroanatomic voltage mapping and endomyocardial biopsy (EMB)
O
Outcome
Association of low-voltage areas with myocyte loss and fibrofatty replacement at endomyocardial biopsysurrogate
Main Result
p-value: p=<0.0001
Three-dimensional electroanatomic voltage mapping enhances the diagnostic accuracy of ARVC/D by identifying low-voltage areas corresponding to fibrofatty replacement and differentiating true ARVC/D from inflammatory cardiomyopathy mimics.
Cite This Study
Corrado et al. (2005) conducted an observational in Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) (n=31). Three-dimensional electroanatomic voltage mapping vs. Normal electroanatomic voltage mapping was evaluated on Association of low-voltage areas with myocyte loss and fibrofatty replacement at endomyocardial biopsy (p=<0.0001). Three-dimensional electroanatomic voltage mapping enhanced ARVC/D diagnostic accuracy by identifying low-voltage areas associated with fibrofatty myocardial replacement (P<0.0001).