Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia

Mikael Laredo, Oholi Tovia-Brodie, Anat Milman, Yoav Michowitz, Rob W. Roudijk, Giovanni Peretto, Nicolas Badenco, Anneline S.J.M. Te Riele, Simone Sala, Guillaume Duthoit, Elena Arbelo, Sandro Ninni, Alessio Gasperetti, J. Peter van Tintelen, Gabriele Paglino, Xavier Waintraub, Antoine Andorin, Petr Peichl, Laurens P. Bosman, Leonardo CaloCarla Giustetto, Andrea Radinovic, Paloma Jorda, Ruben Casado-Arroyo, Esther Zorio, Francisco J. Bermúdez-Jiménez, Elijah R. Behr, Stepan Havranek, Jacob Tfelt-Hansen, Frederic Sacher, Jean Sylvain Hermida, Eyal Nof, Michela Casella, Josef Kautzner, Dominique Lacroix, Josep Brugada, Firat Duru, Paolo Della Bella, Estelle Gandjbakhch, Richard Hauer, Bernard Belhassen

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS: Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data. METHODS AND RESULTS: From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available. Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). T-wave inversion (TWI) was equally frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV. CONCLUSIONS: In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants.

Original languageEnglish
Pages (from-to)1025-1034
Number of pages10
JournalEuropace
Volume25
Issue number3
DOIs
StatePublished - 30 Mar 2023

Keywords

  • Arrhythmogenic cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
  • ECG
  • Site of origin
  • Ventricular arrhythmia

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