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Analysis of local ventricular repolarization using unipolar recordings in patients with arrhythmogenic right ventricular cardiomyopathy

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Abstract

Purpose

In arrhythmogenic right ventricular cardiomyopathy (ARVC), abnormal electroanatomic mapping (EAM) areas are proportional to extent of T-wave inversion on 12-lead ECG. We aimed to evaluate local repolarization changes and their relationship to EAM substrate in ARVC.

Methods

Using unipolar recordings, we analyzed the proportion of negative T waves ≥ 1 mV in depth (NegT), NegT area, Q-Tpeak (QTP), Tpeak-Tend (TPE) intervals and their relationship to bipolar (< 1.5 mV ENDO, < 1.0 mV EPI) and unipolar (< 5.5 mV) endocardial (ENDO) and epicardial (EPI) low-voltage area (LVA) in 21 pts. (15 men, mean age 39 ± 14) with ARVC. Control group included 5 pts. with normal hearts and idiopathic PVCs.

Results

On ENDO, the % of NegT (7 ± 5% vs 30 ± 20%, p = 0.004) and the NegT area (12.9 ± 9.7 c m2 vs 61.4 ± 30.0 cm2, p = 0.001) were smaller in ARVC compared to controls. On EPI, the % of NegT was similar (5 ± 7% vs 3 ± 4%, p = 0.323) and the NegT area, larger (11.0 ± 8.4 cm2 vs 2.7 ± 0.9 cm2, p = 0.027) in ARVC group. In ARVC group, the % of NegT area inside LVA was larger on EPI compared to ENDO for both bipolar (81 ± 27% vs 31 ± 33%, p < 0.001) and unipolar (90 ± 19% vs 73 ± 28%, p = 0.036) recordings. Compared to normal voltage regions, QTP inside ENDO abnormal LVA was on average 58 ± 26 ms shorter and TPE, 25 ± 56 ms longer (97 ± 26 ms and 56 ± 86 ms on EPI, respectively).

Conclusions

In ARVC, NegT areas are more closely associated with abnormal depolarization LVA on the EPI and QTP is shorter and TPE longer inside ENDO and EPI abnormal LVA compared to normal voltage regions. The results add to our understanding of ARVC arrhythmia substrate.

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Funding

This study is funded in part by the F Harlan Batrus EP Research Fund, Katherine M. Miller Research Fund, and the Winkelman Family Fund in Cardiovascular Innovation.

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Authors and Affiliations

  1. Cardiac Electrophysiology Program, Cardiovascular Division Hospital of the University of Pennsylvania, 9 Founders Pavilion – Cardiology, 3400 Spruce St., Philadelphia, PA, 19104, USA

    Maciej Kubala, Shuanglun Xie, Pasquale Santangeli, Fermin C. Garcia, Gregory E. Supple, Robert D. Schaller, Jackson J. Liang, Rajeev K. Pathak, Erica S. Zado, Cory Tschabrunn, Jeffrey Arkles, David J. Callans & Francis E. Marchlinski

  2. Cardiac Arrhythmia Unit, Amiens-Picardie University Hospital, Amiens, France

    Maciej Kubala

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  1. Maciej Kubala
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  2. Shuanglun Xie
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Kubala, M., Xie, S., Santangeli, P. et al. Analysis of local ventricular repolarization using unipolar recordings in patients with arrhythmogenic right ventricular cardiomyopathy. J Interv Card Electrophysiol 57, 261–270 (2020). https://doi.org/10.1007/s10840-019-00594-z

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  • DOI: https://doi.org/10.1007/s10840-019-00594-z

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