TY - JOUR
T1 - Electrocardiographic comparison of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy and right ventricular outflow tract tachycardia
AU - Hoffmayer, Kurt S.
AU - MacHado, Orlando N.
AU - Marcus, Gregory M.
AU - Yang, Yanfei
AU - Johnson, Colleen J.
AU - Ermakov, Simon
AU - Vittinghoff, Eric
AU - Pandurangi, Ulhas
AU - Calkins, Hugh
AU - Cannom, David
AU - Gear, Kathleen C.
AU - Tichnell, Crystal
AU - Park, Young
AU - Zareba, Wojciech
AU - Marcus, Frank I.
AU - Scheinman, Melvin M.
PY - 2011/8/16
Y1 - 2011/8/16
N2 - Objectives: The purpose of this study was to evaluate whether electrocardiographic characteristics of ventricular arrhythmias distinguish patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) from those with right ventricular outflow tract tachycardia (RVOT-VT). Background: Ventricular arrhythmias in RVOT-VT and ARVD/C-VT patients can share a left bundle branch block/inferior axis morphology. Methods: We compared the electrocardiographic morphology of ventricular tachycardia or premature ventricular contractions with left bundle branch block/inferior axis pattern in 16 ARVD/C patients with that in 42 RVOT-VT patients. Results: ARVD/C patients had a significantly longer mean QRS duration in lead I (150 ± 31 ms vs. 123 ± 34 ms, p = 0.006), more often exhibited a precordial transition in lead V6 (3 of 17 [18%] vs. 0 of 42 [0%] with RVOT-VT, p = 0.005), and more often had at least 1 lead with notching (11 of 17 [65%] vs. 9 of 42 [21%], p = 0.001). The most sensitive characteristics for the detection of ARVD/C were a QRS duration in lead I of <120 ms (88% sensitivity, 91% negative predictive value). QRS transition at V6 was most specific at 100% (100% positive predictive value, 77% negative predictive value). The presence of notching on any QRS complex had 79% sensitivity and 65% specificity of (55% positive predictive value, 85% negative predictive value). In multivariate analysis, QRS duration in lead I of <120 ms (odds ratio [OR]: 20.4, p = 0.034), earliest onset QRS in lead V1 (OR: 17.0, p = 0.022), QRS notching (OR: 7.7, p = 0.018), and a transition of V5 or later (OR: 7.0, p = 0.030) each predicted the presence of ARVD/C. Conclusions: Several electrocardiographic criteria can help distinguish right ventricular outflow tract arrhythmias originating from ARVD/C compared with RVOT-VT patients.
AB - Objectives: The purpose of this study was to evaluate whether electrocardiographic characteristics of ventricular arrhythmias distinguish patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) from those with right ventricular outflow tract tachycardia (RVOT-VT). Background: Ventricular arrhythmias in RVOT-VT and ARVD/C-VT patients can share a left bundle branch block/inferior axis morphology. Methods: We compared the electrocardiographic morphology of ventricular tachycardia or premature ventricular contractions with left bundle branch block/inferior axis pattern in 16 ARVD/C patients with that in 42 RVOT-VT patients. Results: ARVD/C patients had a significantly longer mean QRS duration in lead I (150 ± 31 ms vs. 123 ± 34 ms, p = 0.006), more often exhibited a precordial transition in lead V6 (3 of 17 [18%] vs. 0 of 42 [0%] with RVOT-VT, p = 0.005), and more often had at least 1 lead with notching (11 of 17 [65%] vs. 9 of 42 [21%], p = 0.001). The most sensitive characteristics for the detection of ARVD/C were a QRS duration in lead I of <120 ms (88% sensitivity, 91% negative predictive value). QRS transition at V6 was most specific at 100% (100% positive predictive value, 77% negative predictive value). The presence of notching on any QRS complex had 79% sensitivity and 65% specificity of (55% positive predictive value, 85% negative predictive value). In multivariate analysis, QRS duration in lead I of <120 ms (odds ratio [OR]: 20.4, p = 0.034), earliest onset QRS in lead V1 (OR: 17.0, p = 0.022), QRS notching (OR: 7.7, p = 0.018), and a transition of V5 or later (OR: 7.0, p = 0.030) each predicted the presence of ARVD/C. Conclusions: Several electrocardiographic criteria can help distinguish right ventricular outflow tract arrhythmias originating from ARVD/C compared with RVOT-VT patients.
KW - arrhythmogenic right ventricular cardiomyopathy
KW - electrocardiography
KW - right ventricular outflow tract
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U2 - 10.1016/j.jacc.2011.05.017
DO - 10.1016/j.jacc.2011.05.017
M3 - Article
C2 - 21835319
AN - SCOPUS:80051642234
SN - 0735-1097
VL - 58
SP - 831
EP - 838
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -