Tags

Type your tag names separated by a space and hit enter

Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.
J Cardiovasc Electrophysiol. 2016 Apr; 27(4):443-52.JC

Abstract

BACKGROUND

Epsilon waves and other depolarization abnormalities in the right precordial leads are thought to represent delayed activation of the right ventricular outflow tract in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However, no study has directly correlated cardiac electrical activation with the surface ECG findings in ARVD/C.

METHODS AND RESULTS

Thirty ARVD/C patients (mean age 32.7 ± 11.2 years, 16 men) underwent endocardial and epicardial electroanatomical activation mapping in sinus rhythm. Twelve-lead ECGs were classified into 5 patterns: (1) normal QRS (11 patients); (2) terminal activation delay (TAD) (3 patients); (3) incomplete right bundle branch block (IRBBB) (5 patients); (4) epsilon wave (5 patients); (5) complete right bundle branch block (CRBBB) (6 patients). Timing of local ventricular activation and extent of scar was then correlated with surface QRS. Earliest endocardial and epicardial RV activation occurred on the mid anteroseptal wall in all patients despite the CRBBB pattern on ECG. Total RV activation times increased from normal QRS to prolonged TAD, IRBBB, epsilon wave, and CRBBB, respectively (103.9 ± 5.6, 116.3 ± 6.5, 117.8 ± 2.7, 146.4 ± 16.3, and 154.3 ± 6.3, respectively, P < 0.05). The total epicardial scar area (cm(2)) was similar among the different ECG patterns. Median endocardial scar burden was significantly higher in patients with epsilon waves even compared with patients with CRBBB (34.3 vs. 11.3 cm(2) , P < 0.01). Timing of epsilon wave corresponded to activation of the subtricuspid region in all patients.

CONCLUSION

We found that epsilon waves are often associated with severe conduction delay and extensive endocardial scarring in addition to epicardial disease. The timing of epsilon waves on surface ECG correlated with electrical activation of the sub-tricuspid region.

Authors+Show Affiliations

Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26757204

Citation

Tanawuttiwat, Tanyanan, et al. "Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy." Journal of Cardiovascular Electrophysiology, vol. 27, no. 4, 2016, pp. 443-52.
Tanawuttiwat T, Te Riele AS, Philips B, et al. Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. J Cardiovasc Electrophysiol. 2016;27(4):443-52.
Tanawuttiwat, T., Te Riele, A. S., Philips, B., James, C. A., Murray, B., Tichnell, C., Sawant, A. C., Calkins, H., & Tandri, H. (2016). Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. Journal of Cardiovascular Electrophysiology, 27(4), 443-52. https://doi.org/10.1111/jce.12925
Tanawuttiwat T, et al. Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. J Cardiovasc Electrophysiol. 2016;27(4):443-52. PubMed PMID: 26757204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Electroanatomic Correlates of Depolarization Abnormalities in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. AU - Tanawuttiwat,Tanyanan, AU - Te Riele,Anneline S J M, AU - Philips,Binu, AU - James,Cynthia A, AU - Murray,Brittney, AU - Tichnell,Crystal, AU - Sawant,Abhishek C, AU - Calkins,Hugh, AU - Tandri,Harikrishna, Y1 - 2016/02/25/ PY - 2015/11/13/received PY - 2015/12/02/revised PY - 2015/12/08/accepted PY - 2016/1/13/entrez PY - 2016/1/13/pubmed PY - 2017/1/7/medline KW - arrhythmogenic right ventricular KW - catheter ablation KW - dysplasia/cardiomyopathy KW - epicardial mapping KW - epsilon wave KW - right bundle branch block SP - 443 EP - 52 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 27 IS - 4 N2 - BACKGROUND: Epsilon waves and other depolarization abnormalities in the right precordial leads are thought to represent delayed activation of the right ventricular outflow tract in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However, no study has directly correlated cardiac electrical activation with the surface ECG findings in ARVD/C. METHODS AND RESULTS: Thirty ARVD/C patients (mean age 32.7 ± 11.2 years, 16 men) underwent endocardial and epicardial electroanatomical activation mapping in sinus rhythm. Twelve-lead ECGs were classified into 5 patterns: (1) normal QRS (11 patients); (2) terminal activation delay (TAD) (3 patients); (3) incomplete right bundle branch block (IRBBB) (5 patients); (4) epsilon wave (5 patients); (5) complete right bundle branch block (CRBBB) (6 patients). Timing of local ventricular activation and extent of scar was then correlated with surface QRS. Earliest endocardial and epicardial RV activation occurred on the mid anteroseptal wall in all patients despite the CRBBB pattern on ECG. Total RV activation times increased from normal QRS to prolonged TAD, IRBBB, epsilon wave, and CRBBB, respectively (103.9 ± 5.6, 116.3 ± 6.5, 117.8 ± 2.7, 146.4 ± 16.3, and 154.3 ± 6.3, respectively, P < 0.05). The total epicardial scar area (cm(2)) was similar among the different ECG patterns. Median endocardial scar burden was significantly higher in patients with epsilon waves even compared with patients with CRBBB (34.3 vs. 11.3 cm(2) , P < 0.01). Timing of epsilon wave corresponded to activation of the subtricuspid region in all patients. CONCLUSION: We found that epsilon waves are often associated with severe conduction delay and extensive endocardial scarring in addition to epicardial disease. The timing of epsilon waves on surface ECG correlated with electrical activation of the sub-tricuspid region. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/26757204/Electroanatomic_Correlates_of_Depolarization_Abnormalities_in_Arrhythmogenic_Right_Ventricular_Dysplasia/Cardiomyopathy_ L2 - https://doi.org/10.1111/jce.12925 DB - PRIME DP - Unbound Medicine ER -