Epicardial conduction abnormalities in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and mutation positive healthy family members – A study using electrocardiographic imaging

Fig 1. Example of the pattern of terminal ventricular activation in a control subject. The figure presents the area activated during the last 20 msec of the total ventricular epicardial activation (noted with blue color) in a control. Note that the activation during the last 20msec involves the RVOT (a) and parts of LV and RV base (b). a = RV anterior wall, b = RV inferior wall. ARVC = Arrhythmogenic Right Ventricular Cardiomyopathy, RVOT = right ventricular outflow tract, RV = right ventricle, LV = left ventricle.

Fig 2. Examples of terminal ventricular activation in four ARVC patients. The figure presents the area activated during the last 20 msec of the total ventricular epicardial activation (noted with blue colour) in four ARVC patients. Note that the terminal ventricular activation varied among ARVC patients and occurred in the RV inferior wall (a); in three different areas of the RV (paraseptal, RV base and RV free wall)(b); isolated in RVOT (c);and in two separate areas in RVOT and RV base (d). ARVC = Arrhythmogenic Right Ventricular Cardiomyopathy, RVOT = right ventricular outflow tract, RV = right ventricle, LV = left ventricle, TV: tricuspidalis valve, MV: mitralis valve, LAD = left anterior descending coronary artery.

Fig 3. Examples of terminal ventricular activation in four M-carriers. The figure presents the area activated during the last 20 msec of the total ventricular epicardial activation (noted with blue colour) in four M-carriers. Note that the terminal ventricular activation could occur at RVOT and LV base, as in controls (a, b); could additionally involve other parts of the RV, like the inferior wall (c); the terminal ventricular activation could only involve parts of the RV, not involving the LV (d). Same abbreviations as in Fig 2.

Fig 4. Epicardial depolarisation signal morphology per study group and area of interest. The figure summarizes the morphology of the epicardial QRS complexes, per study group and area of interest. The size of the pie chart reflects its proportional size. The p-values refer to the comparison between the three study groups with Kruskal-Wallis test.RV = right ventricle, RVOT = right ventricle outflow tract.

Fig 5. Epicardial repolarisation morphology as reflected by T wave morphology per study group and area of interest. The figure summarizes the morphology of the epicardial T-waves, per study group and area of interest. The size of the pie chart reflects its proportional size. The p-values refer to the comparison between the three study groups with Kruskal-Wallis test. RV = right ventricle, RVOT = right ventricle outflow tract.