TY - JOUR
T1 - Characterization of structural changes in arrhythmogenic right ventricular cardiomyopathy with recurrent ventricular tachycardia after ablation
T2 - Insights from repeat electroanatomic voltage mapping
AU - Briceño, David F.
AU - Liang, Jackson J.
AU - Shirai, Yasuhiro
AU - Markman, Timothy M.
AU - Chahal, Anwar
AU - Tschabrunn, Cory
AU - Zado, Erica
AU - Hyman, Mathew C.
AU - Kumareswaran, Ramanan
AU - Arkles, Jeffery S.
AU - Santangeli, Pasquale
AU - Schaller, Robert D.
AU - Supple, Gregory E.
AU - Frankel, David S.
AU - Deo, Rajat
AU - Riley, Michael P.
AU - Nazarian, Saman
AU - Lin, David
AU - Epstein, Andrew E.
AU - Garcia, Fermin C.
AU - Dixit, Sanjay
AU - Callans, David J.
AU - Marchlinski, Francis E.
N1 - Funding Information:
Funding in part supported by the F. Harlan Batrus Electrophysiology Research Fund, Winkelman Family Fund in Cardiovascular Innovation, and the Katherine J. Miller Research Fund.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background: Data characterizing structural changes of arrhythmogenic right ventricular (RV) cardiomyopathy are limited. Methods: Patients presenting with left bundle branch block ventricular tachycardia in the setting of arrhythmogenic RV cardiomyopathy with procedures separated by at least 9 months were included. Results: Nineteen consecutive patients (84% males; mean age 39±15 years [range, 20-76 years]) were included. All 19 patients underwent 2 detailed sinus rhythm electroanatomic endocardial voltage maps (average 385±177 points per map; range, 93-847 points). Time interval between the initial and repeat ablation procedures was mean 50±37 months (range, 9-162). No significant progression of voltage was observed (bipolar: 38 cm2[interquartile range (IQR), 25-54] versus 53 cm2[IQR, 25-65], P=0.09; unipolar: 116 cm2[IQR, 61-209] versus 159 cm2[IQR, 73-204], P=0.36) for the entire study group. There was a significant increase in RV volumes (percentage increase, 28%; 206 mL [IQR, 170-253] versus 263 mL [IQR, 204-294], P<0.001) for the entire study population. Larger scars at baseline but not changes over time were associated with a significant increase in RV volume (bipolar: Spearman ρ, 0.6965, P=0.006; unipolar: Spearman ρ, 0.5743, P=0.03). Most patients with progressive RV dilatation (8/14, 57%) had moderate (2 patients) or severe (6 patients) tricuspid regurgitation recorded at either initial or repeat ablation procedure. Conclusions: In patients with arrhythmogenic RV cardiomyopathy presenting with recurrent ventricular tachycardia, >10% increase in RV endocardial surface area of bipolar voltage consistent with scar is uncommon during the intermediate term. Most recurrent ventricular tachycardias are localized to regions of prior defined scar. Voltage indexed scar area at baseline but not changes in scar over time is associated with progressive increase in RV size and is consistent with adverse remodeling but not scar progression. Marked tricuspid regurgitation is frequently present in patients with arrhythmogenic RV cardiomyopathy who have progressive RV dilation.
AB - Background: Data characterizing structural changes of arrhythmogenic right ventricular (RV) cardiomyopathy are limited. Methods: Patients presenting with left bundle branch block ventricular tachycardia in the setting of arrhythmogenic RV cardiomyopathy with procedures separated by at least 9 months were included. Results: Nineteen consecutive patients (84% males; mean age 39±15 years [range, 20-76 years]) were included. All 19 patients underwent 2 detailed sinus rhythm electroanatomic endocardial voltage maps (average 385±177 points per map; range, 93-847 points). Time interval between the initial and repeat ablation procedures was mean 50±37 months (range, 9-162). No significant progression of voltage was observed (bipolar: 38 cm2[interquartile range (IQR), 25-54] versus 53 cm2[IQR, 25-65], P=0.09; unipolar: 116 cm2[IQR, 61-209] versus 159 cm2[IQR, 73-204], P=0.36) for the entire study group. There was a significant increase in RV volumes (percentage increase, 28%; 206 mL [IQR, 170-253] versus 263 mL [IQR, 204-294], P<0.001) for the entire study population. Larger scars at baseline but not changes over time were associated with a significant increase in RV volume (bipolar: Spearman ρ, 0.6965, P=0.006; unipolar: Spearman ρ, 0.5743, P=0.03). Most patients with progressive RV dilatation (8/14, 57%) had moderate (2 patients) or severe (6 patients) tricuspid regurgitation recorded at either initial or repeat ablation procedure. Conclusions: In patients with arrhythmogenic RV cardiomyopathy presenting with recurrent ventricular tachycardia, >10% increase in RV endocardial surface area of bipolar voltage consistent with scar is uncommon during the intermediate term. Most recurrent ventricular tachycardias are localized to regions of prior defined scar. Voltage indexed scar area at baseline but not changes in scar over time is associated with progressive increase in RV size and is consistent with adverse remodeling but not scar progression. Marked tricuspid regurgitation is frequently present in patients with arrhythmogenic RV cardiomyopathy who have progressive RV dilation.
KW - cardiomyopathies
KW - catheter ablation
KW - defibrillators, implantable
KW - heart failure
KW - tachycardia, ventricular
KW - tricuspid valve
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U2 - 10.1161/CIRCEP.119.007611
DO - 10.1161/CIRCEP.119.007611
M3 - Article
C2 - 31922914
AN - SCOPUS:85078547717
SN - 1941-3149
VL - 13
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 1
M1 - e007611
ER -