This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Corrado, D. Articles by Thiene, G. Search for Related Content PubMed Articles by Corrado, D. Articles by Thiene, G. Related Collections Related Articles

CLINICAL RESEARCH: HEART RHYTHM DISORDER

Three-Dimensional Electroanatomical Voltage Mapping and Histologic Evaluation of Myocardial Substrate in Right Ventricular Outflow Tract Tachycardia

Domenico Corrado, MD, PhD^_*,_*, Cristina Basso, MD, PhD, Loira Leoni, MD, PhD^_*, Barbara Tokajuk, MD, PhD^_*, Pietro Turrini, MD, PhD^_*, Barbara Bauce, MD, PhD^_*, Federico Migliore, MD^_*, Andrea Pavei, MD^_*, Giuseppe Tarantini, MD, PhD^_*, Massimo Napodano, MD^_*, Angelo Ramondo, MD^_*, Gianfranco Buja, MD^_*, Sabino Iliceto, MD^_* and Gaetano Thiene, MD

^_* Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padua, Italy
Department of Medical-Diagnostic Sciences, University of Padua Medical School, Padua, Italy.

Manuscript received June 11, 2007; revised manuscript received October 24, 2007, accepted November 8, 2007.

^_* Reprint requests and correspondence: Dr. Domenico Corrado, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2-35121 Padova, Italy. (Email: domenico.corrado{at}unipd.it).

Objectives: We tested whether 3-dimensional electroanatomical voltage mapping (EVM) may help in the differential diagnosis between idiopathic right ventricular outflow tract (RVOT) tachycardia and arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D).

Background: Right ventricular EVM has been demonstrated to reliably identify low-voltage regions ("electroanatomical scar"), which in patients with ARVC/D correspond to areas of fibrofatty myocardial replacement.

Methods: The study population comprised 27 patients (15 men and 12 women, age 33.9 ± 8 years) with RVOT tachycardia and no echocardiographic/angiographic evidence of right ventricular (RV) dilation/dysfunction, who underwent EVM and endomyocardial biopsy (EMB) for characterization of ventricular tachycardia (VT) substrate before catheter ablation.

Results: Electroanatomical voltage mapping was normal in 20 of 27 patients (74%, group A), with electrogram voltage >1.5 mV throughout the RV. The other 7 patients (26%, group B) showed 1 (1.4 ± 07) RV electroanatomical scar area(s) (bipolar voltage <0.5 mV) that correlated with fibrofatty myocardial replacement at EMB (p < 0.001). Clinical predictors of RV scar were right precordial QRS prolongation (p < 0.001) and VT inducibility (p = 0.001). Catheter ablation successfully eliminated VT in 18 of 20 patients (90%). During a follow-up of 41 ± 8 months, 3 of 7 patients (43%) from group B received an implantable defibrillator because of life-threatening ventricular arrhythmias, compared with no patients from group A (p = 0.016).

Conclusions: An early/minor form of ARVC/D may mimic idiopathic RVOT tachycardia. Electroanatomical voltage mapping is able to identify RVOT tachycardia due to concealed ARVC/D by detecting RVOT electroanatomical scars that correlate with fibrofatty myocardial replacement at EMB and predispose to sudden arrhythmic death.

Abbreviations and Acronyms   ARVC/D = arrhythmogenic right ventricular cardiomyopathy/dysplasia   CMR = cardiac magnetic resonance   EMB = endomyocardial biopsy   EVM = electroanatomical voltage mapping   LV = left ventricle/ventricular   RV = right ventricle/ventricular   RVOT = right ventricular outflow tract   SAECG = signal-averaged electrocardiogram   VT = ventricular tachycardia

Related Articles

Diagnosing Subtle Forms of Potentially Life-Threatening Diseases

David J. Callans
J. Am. Coll. Cardiol. 2008 51: 740-741. [Full Text] [PDF]

This article has been cited by other articles:

				B. Thomas and N. J. Tavares The right ventricular outflow tract in arrhythmogenic right ventricular cardiomyopathy. J. Am. Coll. Cardiol., October 13, 2009; 54(16): 1558 - 1559. [Full Text] [PDF]

				E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]

				D. Corrado, C. Basso, and G. Thiene Arrhythmogenic right ventricular cardiomyopathy: an update Heart, May 1, 2009; 95(9): 766 - 773. [Full Text] [PDF]

				D. Corrado, C. Basso, A. Pelliccia, and G. Thiene CHAPTER 32 Sports and Heart Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				C. Basso, F. Ronco, F. Marcus, A. Abudureheman, S. Rizzo, A. C. Frigo, B. Bauce, F. Maddalena, A. Nava, D. Corrado, et al. Quantitative assessment of endomyocardial biopsy in arrhythmogenic right ventricular cardiomyopathy/dysplasia: an in vitro validation of diagnostic criteria Eur. Heart J., November 2, 2008; 29(22): 2760 - 2771. [Abstract] [Full Text] [PDF]

				L. T. Cooper Jr Right from the heart: when should myocardial biopsy be performed for suspected arrhythmogenic right ventricular cardiomyopathy/dysplasia? Eur. Heart J., November 2, 2008; 29(22): 2705 - 2707. [Full Text] [PDF]

				D. J. Callans Diagnosing Subtle Forms of Potentially Life-Threatening Diseases. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 740 - 741. [Full Text] [PDF]