High-density mapping demonstrated that definite ARVC patients exhibited significantly greater delay in activation times at short coupling intervals compared to patients with benign RVOT ectopy.
Observational (n=48)
Single-blind
No
Does high-density mapping and paced surface ECG analysis during an S1-S2 restitution protocol differentiate early ARVC from benign RVOT ectopy in patients without structural heart disease?
Dynamic conduction and repolarization changes during programmed stimulation can help differentiate early, concealed ARVC from benign RVOT ectopy before structural abnormalities appear.
Tasa de eventos absoluta: 43% vs 36%
valor p: p=0.03
AIMS: The concealed phase of arrhythmogenic right ventricular cardiomyopathy (ARVC) may initially manifest electrophysiologically. No studies have examined dynamic conduction/repolarization kinetics to distinguish benign right ventricular outflow tract ectopy (RVOT ectopy) from ARVC's early phase. We investigated dynamic endocardial electrophysiological changes that differentiate early ARVC disease expression from RVOT ectopy. METHODS: 22 ARVC (12 definite based upon family history and mutation carrier status, 10 probable) patients without right ventricular structural anomalies underwent high-density non-contact mapping of the right ventricle. These were compared to data from 14 RVOT ectopy and 12 patients with supraventricular tachycardias and normal hearts. Endocardial RVOT ectopy: 5 ± 14, Normal: 1 ± 18, p<0.05). Surface ECG correlates of these intracardiac measurements demonstrated an increase of greater than 48 ms in stimulus to surface ECG J-point pre-ERP versus steady state, with an 88% specificity and 68% sensitivity in distinguishing definite ARVC from the other groups. This technique could not distinguish patients with genetic predisposition to ARVC only (probable ARVC) from controls. CONCLUSIONS: Significant changes in dynamic conduction and repolarization are apparent in early ARVC before detectable RV structural abnormalities, and were present to a lesser degree in probable ARVC patients. Investigation of dynamic electrophysiological parameters may be useful to identify concealed ARVC in patients without disease pedigrees by using endocardial electrogram or paced ECG parameters.
Finlay et al. (Fri,) conducted a observational in Early Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) (n=48). High-density non-contact mapping and S1-S2 restitution protocol vs. Benign right ventricular outflow tract ectopy (RVOT ectopy) and normal controls was evaluated on Delay in Activation Times at coupling intervals just above the ventricular effective refractory period (VERP) (p=0.03). High-density mapping demonstrated that definite ARVC patients exhibited significantly greater delay in activation times at short coupling intervals compared to patients with benign RVOT ectopy.