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The two predominant etiologies of right ventricular tachycardia (VT) are arrhythmogenic right ventricular cardiomyopathy (ARVC) and idiopathic VT arising from the right ventricular outflow tract (RVOT). Discrimination between these 2 entities is critical, as their prognoses and therapeutic options differ. The Tpeak-Tend (Tpe) interval reflects the transmural repolarization dispersion and is associated with high mortality.
We compared the sinus rhythm ECG of 38 patients (21 M, 44±15y) with VT originating from right ventricle. Tpe interval was measured in each precordial lead by a single blinded observer.
25 patients (16 M, 42±16y) met the Task Force criteria for the diagnosis of ARVC, and 13 patients (7 M, 45±14y) had idiopathic RVOT tachycardia. Patients with ARVC had significantly prolonged Tpe intervals in both precordial leads than patients with idiopathic RVOT VT (137.1±32.6 ms vs 93.8±16.9 ms; p<0.001 in V1, 133.2±35.5 ms vs 104.7±16.9 ms; p=0.01 in V2, 125.7±31.5 ms vs 99.1±19.6 ms; p=0.09 in V3, 121.9±26.5 ms vs 92.3±19.7 ms; p=0.001 in V4, 123.1±26.5 ms vs 99.5±20:1 ms; p=0.04 in V5 and 126.9±32.2 ms vs 89±11.3 ms; p<0.001 in V6, respectively. For the diagnosis of ARVC, Tpe cut-off value of 97 ms in V1 had 84% sensitivity and 62% specificity (AUC=0.880).
In conclusion, in patients with VT of RV origin, the prolonged Tpe interval in sinus rhythm electrocardiogram supports the diagnosis of ARVC.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Ventricular Arrhythmias in Cardiomyopathy
Abstract Category: 7. Arrhythmias: VT
Presentation Number: 1104-28
- 2013 American College of Cardiology Foundation