Right ventricular scar-related ventricular tachycardia in nonischemic cardiomyopathy

Electrophysiological characteristics, mapping, and ablation of underlying heart disease

Saurabh Kumar, Samuel H. Baldinger, Sunil Kapur, Jorge E. Romero, Nishaki K. Mehta, Saagar Mahida, Akira Fujii, Usha B. Tedrow, William G. Stevenson

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Right ventricular (RV)-scar related ventricular tachycardia (VT) is often due to arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) or cardiac sarcoidosis (CS), but some patients whose clinical course has not been described do not fulfill diagnostic criteria for these diseases. We sought to characterize the electrophysiologic substrate and catheter ablation outcomes of such patients, termed RV cardiomyopathy of unknown source (RCUS). Methods and results: Data of 100 consecutive patients who presented with RV cardiomyopathy and/or RV-related VT for ablation were reviewed (51 ARVC/D, 22 CS; 27 RCUS). Compared to ARVC/D, RCUS patients were older (P = 0.001), less commonly had RV dilatation (P = 0.001) or dysfunction (P = 0.01) and fragmented QRS, parietal block, and T-wave inversion. Compared to CS, R-CUS patients had less severe LV dysfunction. Extent and distribution of endocardial/epicardial scar and inducible VTs in RCUS patients were comparable with ARVC/D and CS patients. At a median follow-up of 23 months, RCUS patients had more favorable VT-free survival (RCUS 71%, ARVC/D 60%, CS 41%, P = 0.03) and survival free of death or cardiac transplant (RCUS 92%, ARVC/D 92%, CS 62%, P = 0.01). No RCUS patients developed new criteria for ARVC/D or CS in follow-up. Conclusions: Up to one-third of patients with RV scar-related VT are not classifiable as ARVC/D or CS. These patients had a somewhat better prognosis than ARVC/D or sarcoid and did not develop evidence of these diseases during the initial 2 years of follow-up. The extent to which this population comprises mild ARVC/D, CS, or other diseases is not clear. Journal compilation

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2017

Fingerprint

Arrhythmogenic Right Ventricular Dysplasia
Ventricular Tachycardia
Cardiomyopathies
Sarcoidosis
Cicatrix
Heart Diseases
Patient Rights
Catheter Ablation
Survival
Dilatation

Keywords

  • Arrhythmogenic right ventricular dysplasia
  • Catheter ablation
  • Right ventricular cardiomyopathy
  • Sarcoidosis
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Right ventricular scar-related ventricular tachycardia in nonischemic cardiomyopathy : Electrophysiological characteristics, mapping, and ablation of underlying heart disease. / Kumar, Saurabh; Baldinger, Samuel H.; Kapur, Sunil; Romero, Jorge E.; Mehta, Nishaki K.; Mahida, Saagar; Fujii, Akira; Tedrow, Usha B.; Stevenson, William G.

In: Journal of Cardiovascular Electrophysiology, 2017.

Research output: Contribution to journalArticle

Kumar, Saurabh ; Baldinger, Samuel H. ; Kapur, Sunil ; Romero, Jorge E. ; Mehta, Nishaki K. ; Mahida, Saagar ; Fujii, Akira ; Tedrow, Usha B. ; Stevenson, William G. / Right ventricular scar-related ventricular tachycardia in nonischemic cardiomyopathy : Electrophysiological characteristics, mapping, and ablation of underlying heart disease. In: Journal of Cardiovascular Electrophysiology. 2017.
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abstract = "Background: Right ventricular (RV)-scar related ventricular tachycardia (VT) is often due to arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) or cardiac sarcoidosis (CS), but some patients whose clinical course has not been described do not fulfill diagnostic criteria for these diseases. We sought to characterize the electrophysiologic substrate and catheter ablation outcomes of such patients, termed RV cardiomyopathy of unknown source (RCUS). Methods and results: Data of 100 consecutive patients who presented with RV cardiomyopathy and/or RV-related VT for ablation were reviewed (51 ARVC/D, 22 CS; 27 RCUS). Compared to ARVC/D, RCUS patients were older (P = 0.001), less commonly had RV dilatation (P = 0.001) or dysfunction (P = 0.01) and fragmented QRS, parietal block, and T-wave inversion. Compared to CS, R-CUS patients had less severe LV dysfunction. Extent and distribution of endocardial/epicardial scar and inducible VTs in RCUS patients were comparable with ARVC/D and CS patients. At a median follow-up of 23 months, RCUS patients had more favorable VT-free survival (RCUS 71{\%}, ARVC/D 60{\%}, CS 41{\%}, P = 0.03) and survival free of death or cardiac transplant (RCUS 92{\%}, ARVC/D 92{\%}, CS 62{\%}, P = 0.01). No RCUS patients developed new criteria for ARVC/D or CS in follow-up. Conclusions: Up to one-third of patients with RV scar-related VT are not classifiable as ARVC/D or CS. These patients had a somewhat better prognosis than ARVC/D or sarcoid and did not develop evidence of these diseases during the initial 2 years of follow-up. The extent to which this population comprises mild ARVC/D, CS, or other diseases is not clear. Journal compilation",
keywords = "Arrhythmogenic right ventricular dysplasia, Catheter ablation, Right ventricular cardiomyopathy, Sarcoidosis, Ventricular tachycardia",
author = "Saurabh Kumar and Baldinger, {Samuel H.} and Sunil Kapur and Romero, {Jorge E.} and Mehta, {Nishaki K.} and Saagar Mahida and Akira Fujii and Tedrow, {Usha B.} and Stevenson, {William G.}",
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T1 - Right ventricular scar-related ventricular tachycardia in nonischemic cardiomyopathy

T2 - Electrophysiological characteristics, mapping, and ablation of underlying heart disease

AU - Kumar, Saurabh

AU - Baldinger, Samuel H.

AU - Kapur, Sunil

AU - Romero, Jorge E.

AU - Mehta, Nishaki K.

AU - Mahida, Saagar

AU - Fujii, Akira

AU - Tedrow, Usha B.

AU - Stevenson, William G.

PY - 2017

Y1 - 2017

N2 - Background: Right ventricular (RV)-scar related ventricular tachycardia (VT) is often due to arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) or cardiac sarcoidosis (CS), but some patients whose clinical course has not been described do not fulfill diagnostic criteria for these diseases. We sought to characterize the electrophysiologic substrate and catheter ablation outcomes of such patients, termed RV cardiomyopathy of unknown source (RCUS). Methods and results: Data of 100 consecutive patients who presented with RV cardiomyopathy and/or RV-related VT for ablation were reviewed (51 ARVC/D, 22 CS; 27 RCUS). Compared to ARVC/D, RCUS patients were older (P = 0.001), less commonly had RV dilatation (P = 0.001) or dysfunction (P = 0.01) and fragmented QRS, parietal block, and T-wave inversion. Compared to CS, R-CUS patients had less severe LV dysfunction. Extent and distribution of endocardial/epicardial scar and inducible VTs in RCUS patients were comparable with ARVC/D and CS patients. At a median follow-up of 23 months, RCUS patients had more favorable VT-free survival (RCUS 71%, ARVC/D 60%, CS 41%, P = 0.03) and survival free of death or cardiac transplant (RCUS 92%, ARVC/D 92%, CS 62%, P = 0.01). No RCUS patients developed new criteria for ARVC/D or CS in follow-up. Conclusions: Up to one-third of patients with RV scar-related VT are not classifiable as ARVC/D or CS. These patients had a somewhat better prognosis than ARVC/D or sarcoid and did not develop evidence of these diseases during the initial 2 years of follow-up. The extent to which this population comprises mild ARVC/D, CS, or other diseases is not clear. Journal compilation

AB - Background: Right ventricular (RV)-scar related ventricular tachycardia (VT) is often due to arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) or cardiac sarcoidosis (CS), but some patients whose clinical course has not been described do not fulfill diagnostic criteria for these diseases. We sought to characterize the electrophysiologic substrate and catheter ablation outcomes of such patients, termed RV cardiomyopathy of unknown source (RCUS). Methods and results: Data of 100 consecutive patients who presented with RV cardiomyopathy and/or RV-related VT for ablation were reviewed (51 ARVC/D, 22 CS; 27 RCUS). Compared to ARVC/D, RCUS patients were older (P = 0.001), less commonly had RV dilatation (P = 0.001) or dysfunction (P = 0.01) and fragmented QRS, parietal block, and T-wave inversion. Compared to CS, R-CUS patients had less severe LV dysfunction. Extent and distribution of endocardial/epicardial scar and inducible VTs in RCUS patients were comparable with ARVC/D and CS patients. At a median follow-up of 23 months, RCUS patients had more favorable VT-free survival (RCUS 71%, ARVC/D 60%, CS 41%, P = 0.03) and survival free of death or cardiac transplant (RCUS 92%, ARVC/D 92%, CS 62%, P = 0.01). No RCUS patients developed new criteria for ARVC/D or CS in follow-up. Conclusions: Up to one-third of patients with RV scar-related VT are not classifiable as ARVC/D or CS. These patients had a somewhat better prognosis than ARVC/D or sarcoid and did not develop evidence of these diseases during the initial 2 years of follow-up. The extent to which this population comprises mild ARVC/D, CS, or other diseases is not clear. Journal compilation

KW - Arrhythmogenic right ventricular dysplasia

KW - Catheter ablation

KW - Right ventricular cardiomyopathy

KW - Sarcoidosis

KW - Ventricular tachycardia

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