Electrocardiographic Predictors of Electroanatomic Scar Size in Arrhythmogenic Right Ventricular Cardiomyopathy: Implications for Arrhythmic Risk Stratification

Authors

  • ALESSANDRO ZORZI M.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • FEDERICO MIGLIORE M.D., Ph.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • MOHAMED ELMAGHAWRY M.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
    2. Department of Cardiology, Aswan Heart Center, Aswan, Egypt
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  • MARIA SILVANO M.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • MARTINA PERAZZOLO MARRA M.D., Ph.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • ALICE NIERO M.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • KIM NGUYEN M.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • ILARIA RIGATO M.D., Ph.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • BARBARA BAUCE M.D, Ph.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • CRISTINA BASSO M.D., Ph.D.,

    1. Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • GAETANO THIENE M.D.,

    1. Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • SABINO ILICETO M.D.,

    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • DOMENICO CORRADO M.D., Ph.D.

    Corresponding author
    1. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
    • Address for correspondence: Domenico Corrado, M.D., Ph.D., Inherited Arrhythmogenic Cardiomyopathy Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padua Medical School, Via N. Giustiniani 2, 35121 Padova, Italy. Fax: +39 049 8212309; E-mail: domenico.corrado@unipd.it

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  • The study was supported by Registry of Cardio-Cerebro-Vascular Pathology, Veneto Region, Venice, Italy, and Fondazione Cariparo, Padova and Rovigo, Italy

  • No disclosures.

ECG Predictors of Electroanatomic Scar in ARVC

Introduction

The extent of right ventricular (RV) electroanatomic scar (EAS) detected by endocardial voltage mapping (EVM) is a powerful invasive predictor of arrhythmic outcome in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Electrocardiogram (ECG) and signal-averaged ECG are noninvasive tools of established clinical value for the diagnosis of electrical abnormalities in ARVC. This study was designed to assess the role of ECG and SAECG abnormalities for noninvasive estimation of the extent and regional distribution of RV-EAS and prediction of scar-related arrhythmic risk.

Methods and Results

The study population included 49 consecutive patients (38 males, median age 35 years) with a definite diagnosis of ARVC and an abnormal EVM by CARTO system. At univariate analysis, the presence of epsilon waves, the degree of RV dilation, the severity of RV dysfunction, and the extent of negative T waves correlated with RV-EAS% area. Normal T-waves were associated with a median RV-EAS% area of 4.9% (4.5–6.4), negative T waves in V1–V3 of 22.0% (8.5–30.6), negative T waves in V1–V3 extending to lateral precordial leads (V4–V6) of 26.8% (11.5–35.2), and negative T waves in both precordial (V2–V6) and inferior leads of 30.2% (24.8–33.0) (P < 0.001). At multivariate analysis, the extent of negative T waves remained the only independent predictor of RV-EAS% area (B = 4.4, 95%CI 1.3–7.4, P = 0.006) and correlated with the arrhythmic event-rate during follow-up (P = 0.03).

Conclusions

In patients with ARVC, the extent of negative T-waves across 12-lead ECG allows noninvasive estimation of the amount of RV-EAS and prediction of EAS-related arrhythmic risk.

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