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Histologic findings in patients with clinical and instrumental diagnosis of sporadic arrhythmogenic right ventricular dysplasia

Cristina Chimenti, MD, PhD^*, Maurizio Pieroni, MD^*, Attilio Maseri, MD^* and Andrea Frustaci, MD^,*

^* Cardio-Thoracic and Vascular Department, San Raffaele Hospital, Milan, Italy
Cardiology Department, Catholic University, Rome, Italy

View larger version (120K): [in a new window]   Figure 1 12-lead electrocardiogram from a 27-year-old man with palpitations, showing a sustained ventricular tachycardia with left bundle branch block morphology.

View larger version (119K): [in a new window]   Figure 2 12-lead electrocardiogram from a 29-year-old woman presenting with syncope, showing a sustained ventricular tachycardia with left bundle branch block pattern.

View larger version (116K): [in a new window]   Figure 3 Right ventricular angiography (20° right anterior oblique projection) from patient of Figure 1, showing multiple small aneurysms of the inferior wall.

View larger version (130K): [in a new window]   Figure 4 Right ventricular angiography (30° right anterior oblique view) from patient of Figure 2, showing small localized aneurysms of the inferior and posterior wall.

View larger version (132K): [in a new window]   Figure 5 Right ventricular endomyocardial biopsy from patient of Figures 1 and 3, showing a severe fibrofatty infiltration of the myocardium, suggesting an arrhythmogenic right ventricular dysplasia (hematoxylin eosin 100x).

View larger version (151K): [in a new window]   Figure 6 Endomyocardial biopsy from the right ventricle from patients of Figures 2 and 4, showing an active lymphocytic myocarditis (arrows) (HE 250x) with areas of interstitial and replacement fibrosis (F).

View larger version (20K): [in a new window]   Figure 7 Percentage of myocytes (Myo), adipose tissue (Adi), fibrosis (Fibr), and interstitium (Int) (other interstitial structures not including adipose and fibrous tissue) in the myocardium of controls, myocarditis, and arrhythmogenic right ventricular dysplasia (ARVD). Results are mean ± SD. *p < 0.001 ARVD vs. controls; p < 0.001 ARVD vs. myocarditis; p < 0.05 myocarditis vs. controls; p < 0.05 myocarditis vs. ARVD.