Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy

Pasquale Santangeli, Maurizio Pieroni, Antonio Dello Russo, Michela Casella, Gemma Pelargonio, Andrea Macchione, Antonia Camporeale, Costantino Smaldone, Stefano Bartoletti, Luigi Di Biase, Fulvio Bellocci, Andrea Natale

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background-The diagnostic reliability and pathophysiologic relevance of different noninvasive diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are undefined. We tested the association between noninvasive diagnostic criteria for ARVC and the presence of low-voltage areas (LVAs) detected at electroanatomic voltage mapping (EAM). Methods and Results-Noninvasive diagnostic criteria, including ECG, signal-averaged ECG (SAECG), and cardiac magnetic resonance (CMR) criteria, were compared with the presence and location of LVAs detected at right ventricular (RV) EAM in 17 patients (9 men) aged 50±16 years with biopsy specimen-proven ARVC. LVAs were found in 15 (88%) patients. Patients with surface ECG abnormalities showed a higher degree of RV involvement than those without ECG abnormalities (number of LVAs, 1.8±0.5 versus 0.9±0.6, respectively; P<0.01). A significant association was found between SAECG abnormalities and LVAs in the RV outflow tract (P=0.03) but not between SAECG parameters and LVAs in other RV regions. Among CMR findings, RV delayed enhancement was more significantly associated with the distribution of LVAs (free wall, P<0.01; outflow tract, P<0.01; posteroinferior wall, P=0.02). Regional RV dysfunction also showed a good correlation with LVAs, with the most significant association being found with the free wall (P=0.01), whereas RV fat infiltration at CMR was not correlated with LVAs. Conclusion-In patients with ARVC, SAECG abnormalities correlate with the presence of LVAs selectively in the RV outflow tract, whereas surface ECG abnormalities are associated with a more diffuse RV involvement. Myocardial delayed enhancement is the CMR finding more strongly associated with LVAs, thus supporting the appropriateness of its inclusion among diagnostic criteria for ARVC.

Original languageEnglish (US)
Pages (from-to)632-638
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume3
Issue number6
DOIs
StatePublished - Dec 2010
Externally publishedYes

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Arrhythmogenic Right Ventricular Dysplasia
Electrocardiography
Magnetic Resonance Spectroscopy
Right Ventricular Dysfunction
Fats
Biopsy

Keywords

  • Arrhythmogenic right ventricular dysplasia
  • Diagnosis
  • Electrocardiography
  • Magnetic resonance
  • Mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Santangeli, P., Pieroni, M., Dello Russo, A., Casella, M., Pelargonio, G., Macchione, A., ... Natale, A. (2010). Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy. Circulation: Arrhythmia and Electrophysiology, 3(6), 632-638. https://doi.org/10.1161/CIRCEP.110.958116

Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy. / Santangeli, Pasquale; Pieroni, Maurizio; Dello Russo, Antonio; Casella, Michela; Pelargonio, Gemma; Macchione, Andrea; Camporeale, Antonia; Smaldone, Costantino; Bartoletti, Stefano; Di Biase, Luigi; Bellocci, Fulvio; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 3, No. 6, 12.2010, p. 632-638.

Research output: Contribution to journalArticle

Santangeli, P, Pieroni, M, Dello Russo, A, Casella, M, Pelargonio, G, Macchione, A, Camporeale, A, Smaldone, C, Bartoletti, S, Di Biase, L, Bellocci, F & Natale, A 2010, 'Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy', Circulation: Arrhythmia and Electrophysiology, vol. 3, no. 6, pp. 632-638. https://doi.org/10.1161/CIRCEP.110.958116
Santangeli, Pasquale ; Pieroni, Maurizio ; Dello Russo, Antonio ; Casella, Michela ; Pelargonio, Gemma ; Macchione, Andrea ; Camporeale, Antonia ; Smaldone, Costantino ; Bartoletti, Stefano ; Di Biase, Luigi ; Bellocci, Fulvio ; Natale, Andrea. / Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy. In: Circulation: Arrhythmia and Electrophysiology. 2010 ; Vol. 3, No. 6. pp. 632-638.
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title = "Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy",
abstract = "Background-The diagnostic reliability and pathophysiologic relevance of different noninvasive diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are undefined. We tested the association between noninvasive diagnostic criteria for ARVC and the presence of low-voltage areas (LVAs) detected at electroanatomic voltage mapping (EAM). Methods and Results-Noninvasive diagnostic criteria, including ECG, signal-averaged ECG (SAECG), and cardiac magnetic resonance (CMR) criteria, were compared with the presence and location of LVAs detected at right ventricular (RV) EAM in 17 patients (9 men) aged 50±16 years with biopsy specimen-proven ARVC. LVAs were found in 15 (88{\%}) patients. Patients with surface ECG abnormalities showed a higher degree of RV involvement than those without ECG abnormalities (number of LVAs, 1.8±0.5 versus 0.9±0.6, respectively; P<0.01). A significant association was found between SAECG abnormalities and LVAs in the RV outflow tract (P=0.03) but not between SAECG parameters and LVAs in other RV regions. Among CMR findings, RV delayed enhancement was more significantly associated with the distribution of LVAs (free wall, P<0.01; outflow tract, P<0.01; posteroinferior wall, P=0.02). Regional RV dysfunction also showed a good correlation with LVAs, with the most significant association being found with the free wall (P=0.01), whereas RV fat infiltration at CMR was not correlated with LVAs. Conclusion-In patients with ARVC, SAECG abnormalities correlate with the presence of LVAs selectively in the RV outflow tract, whereas surface ECG abnormalities are associated with a more diffuse RV involvement. Myocardial delayed enhancement is the CMR finding more strongly associated with LVAs, thus supporting the appropriateness of its inclusion among diagnostic criteria for ARVC.",
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T1 - Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy

AU - Santangeli, Pasquale

AU - Pieroni, Maurizio

AU - Dello Russo, Antonio

AU - Casella, Michela

AU - Pelargonio, Gemma

AU - Macchione, Andrea

AU - Camporeale, Antonia

AU - Smaldone, Costantino

AU - Bartoletti, Stefano

AU - Di Biase, Luigi

AU - Bellocci, Fulvio

AU - Natale, Andrea

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N2 - Background-The diagnostic reliability and pathophysiologic relevance of different noninvasive diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are undefined. We tested the association between noninvasive diagnostic criteria for ARVC and the presence of low-voltage areas (LVAs) detected at electroanatomic voltage mapping (EAM). Methods and Results-Noninvasive diagnostic criteria, including ECG, signal-averaged ECG (SAECG), and cardiac magnetic resonance (CMR) criteria, were compared with the presence and location of LVAs detected at right ventricular (RV) EAM in 17 patients (9 men) aged 50±16 years with biopsy specimen-proven ARVC. LVAs were found in 15 (88%) patients. Patients with surface ECG abnormalities showed a higher degree of RV involvement than those without ECG abnormalities (number of LVAs, 1.8±0.5 versus 0.9±0.6, respectively; P<0.01). A significant association was found between SAECG abnormalities and LVAs in the RV outflow tract (P=0.03) but not between SAECG parameters and LVAs in other RV regions. Among CMR findings, RV delayed enhancement was more significantly associated with the distribution of LVAs (free wall, P<0.01; outflow tract, P<0.01; posteroinferior wall, P=0.02). Regional RV dysfunction also showed a good correlation with LVAs, with the most significant association being found with the free wall (P=0.01), whereas RV fat infiltration at CMR was not correlated with LVAs. Conclusion-In patients with ARVC, SAECG abnormalities correlate with the presence of LVAs selectively in the RV outflow tract, whereas surface ECG abnormalities are associated with a more diffuse RV involvement. Myocardial delayed enhancement is the CMR finding more strongly associated with LVAs, thus supporting the appropriateness of its inclusion among diagnostic criteria for ARVC.

AB - Background-The diagnostic reliability and pathophysiologic relevance of different noninvasive diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are undefined. We tested the association between noninvasive diagnostic criteria for ARVC and the presence of low-voltage areas (LVAs) detected at electroanatomic voltage mapping (EAM). Methods and Results-Noninvasive diagnostic criteria, including ECG, signal-averaged ECG (SAECG), and cardiac magnetic resonance (CMR) criteria, were compared with the presence and location of LVAs detected at right ventricular (RV) EAM in 17 patients (9 men) aged 50±16 years with biopsy specimen-proven ARVC. LVAs were found in 15 (88%) patients. Patients with surface ECG abnormalities showed a higher degree of RV involvement than those without ECG abnormalities (number of LVAs, 1.8±0.5 versus 0.9±0.6, respectively; P<0.01). A significant association was found between SAECG abnormalities and LVAs in the RV outflow tract (P=0.03) but not between SAECG parameters and LVAs in other RV regions. Among CMR findings, RV delayed enhancement was more significantly associated with the distribution of LVAs (free wall, P<0.01; outflow tract, P<0.01; posteroinferior wall, P=0.02). Regional RV dysfunction also showed a good correlation with LVAs, with the most significant association being found with the free wall (P=0.01), whereas RV fat infiltration at CMR was not correlated with LVAs. Conclusion-In patients with ARVC, SAECG abnormalities correlate with the presence of LVAs selectively in the RV outflow tract, whereas surface ECG abnormalities are associated with a more diffuse RV involvement. Myocardial delayed enhancement is the CMR finding more strongly associated with LVAs, thus supporting the appropriateness of its inclusion among diagnostic criteria for ARVC.

KW - Arrhythmogenic right ventricular dysplasia

KW - Diagnosis

KW - Electrocardiography

KW - Magnetic resonance

KW - Mapping

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