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 Calo; Carla 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

doi:10.1093/europace/euac267

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

^*Corresponding author for this work

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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 From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) and ^results 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%).

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 language	English
Pages (from-to)	1025-1034
Number of pages	10
Journal	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
Volume	25
Issue number	3
Early online date	13 Jan 2023
DOIs	https://doi.org/10.1093/europace/euac267
Publication status	Published - 30 Mar 2023

Keywords

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

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Laredo, M., Tovia-Brodie, O., Milman, A., Michowitz, Y., Roudijk, R. W., Peretto, G., Badenco, N., Te Riele, A. S. J. M., Sala, S., Duthoit, G., Arbelo, E., Ninni, S., Gasperetti, A., van Tintelen, J. P., Paglino, G., Waintraub, X., Andorin, A., Peichl, P., Bosman, L. P., ... Belhassen, B. (2023). Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 25(3), 1025-1034. https://doi.org/10.1093/europace/euac267

Laredo, Mikael ; Tovia-Brodie, Oholi ; Milman, Anat et al. / Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia. In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2023 ; Vol. 25, No. 3. pp. 1025-1034.

@article{34cf62e27e6d483d9a1b1d09ec07ab7a,

title = "Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia",

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 From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) and results 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%).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.",

keywords = "Arrhythmogenic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, ECG, Site of origin, Ventricular arrhythmia",

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

year = "2023",

month = mar,

day = "30",

doi = "10.1093/europace/euac267",

language = "English",

volume = "25",

pages = "1025--1034",

number = "3",

}

Laredo, M, Tovia-Brodie, O, Milman, A, Michowitz, Y, Roudijk, RW, Peretto, G, Badenco, N, Te Riele, ASJM, Sala, S, Duthoit, G, Arbelo, E, Ninni, S, Gasperetti, A, van Tintelen, JP, Paglino, G, Waintraub, X, Andorin, A, Peichl, P, Bosman, LP, Calo, L, Giustetto, C, Radinovic, A, Jorda, P, Casado-Arroyo, R, Zorio, E, Bermúdez-Jiménez, FJ, Behr, ER, Havranek, S, Tfelt-Hansen, J, Sacher, F, Hermida, J-S, Nof, E, Casella, M, Kautzner, J, Lacroix, D, Brugada, J, Duru, F, Bella, PD, Gandjbakhch, E, Hauer, R & Belhassen, B 2023, 'Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia', Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, vol. 25, no. 3, pp. 1025-1034. https://doi.org/10.1093/europace/euac267

Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia. / Laredo, Mikael; Tovia-Brodie, Oholi; Milman, Anat et al.
In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 25, No. 3, 30.03.2023, p. 1025-1034.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia

AU - Laredo, Mikael

AU - Tovia-Brodie, Oholi

AU - Milman, Anat

AU - Michowitz, Yoav

AU - Roudijk, Rob W

AU - Peretto, Giovanni

AU - Badenco, Nicolas

AU - Te Riele, Anneline S J M

AU - Sala, Simone

AU - Duthoit, Guillaume

AU - Arbelo, Elena

AU - Ninni, Sandro

AU - Gasperetti, Alessio

AU - van Tintelen, J Peter

AU - Paglino, Gabriele

AU - Waintraub, Xavier

AU - Andorin, Antoine

AU - Peichl, Petr

AU - Bosman, Laurens P

AU - Calo, Leonardo

AU - Giustetto, Carla

AU - Radinovic, Andrea

AU - Jorda, Paloma

AU - Casado-Arroyo, Ruben

AU - Zorio, Esther

AU - Bermúdez-Jiménez, Francisco J

AU - Behr, Elijah R

AU - Havranek, Stepan

AU - Tfelt-Hansen, Jacob

AU - Sacher, Frederic

AU - Hermida, Jean-Sylvain

AU - Nof, Eyal

AU - Casella, Michela

AU - Kautzner, Josef

AU - Lacroix, Dominique

AU - Brugada, Josep

AU - Duru, Firat

AU - Bella, Paolo Della

AU - Gandjbakhch, Estelle

AU - Hauer, Richard

AU - Belhassen, Bernard

PY - 2023/3/30

Y1 - 2023/3/30

N2 - 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 From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) and results 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%).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.

AB - 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 From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) and results 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%).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.

KW - Arrhythmogenic cardiomyopathy

KW - Arrhythmogenic right ventricular cardiomyopathy

KW - ECG

KW - Site of origin

KW - Ventricular arrhythmia

UR - http://www.scopus.com/inward/record.url?scp=85151573534&partnerID=8YFLogxK

U2 - 10.1093/europace/euac267

DO - 10.1093/europace/euac267

M3 - Article

C2 - 36635857

SN - 1099-5129

VL - 25

SP - 1025

EP - 1034

JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

IS - 3

ER -

Laredo M, Tovia-Brodie O, Milman A, Michowitz Y, Roudijk RW, Peretto G et al. Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2023 Mar 30;25(3):1025-1034. Epub 2023 Jan 13. doi: 10.1093/europace/euac267

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

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