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Application of noninvasive signal-averaged electrocardiogram analysis in predicting the requirement of epicardial ablation in patients with arrhythmogenic right ventricular cardiomyopathy.

Abstract：

BACKGROUND:Signal-averaged electrocardiogram (SAECG) provides not only diagnostic information but also the prognostic implication of ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC). OBJECTIVE:This study aimed to validate the role of SAECG in identifying arrhythmogenic substrates requiring an epicardial approach in ARVC. METHODS:Ninety-one patients with a definite diagnosis of ARVC who underwent successful ablation for drug-refractory ventricular arrhythmia were enrolled and classified into 2 groups: group 1 who underwent successful ablation at the endocardium only and group 2 who underwent successful ablation requiring an additional epicardial approach. The baseline characteristics of patients and SAECG parameters were obtained for analysis. RESULTS:Male predominance, worse right ventricular (RV) function, higher incidence of syncope, and depolarization abnormality were observed in group 2. Moreover, the number of abnormal SAECG criteria was higher in group 2 than in group 1. After a multivariate analysis, the independent predictors of the requirement of epicardial ablation included the number of abnormal SAECG criteria (odds ratio 2.8, 95% confidence interval 1.4-5.4; P = .003) and presence of syncope (odds ratio 11.7; 95% confidence interval 2.7-50.4; P = .001). In addition, ≥2 abnormal SAECG criteria were associated with larger RV endocardial unipolar low-voltage zone (P < .001), larger RV endocardial/epicardial bipolar low-voltage zone/scar (P < .05), and longer RV endocardial/epicardial total activation time (P < .001 and P = .004, respectively). CONCLUSION:The number of abnormal SAECG criteria was correlated with the extent of diseased epicardial substrates and could be a potential surrogate marker for predicting the requirement of epicardial ablation in patients with ARVC.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Chung FP,Lin CY,Lin YJ,Chang SL,Lo LW,Hu YF,Tuan TC,Chao TF,Liao JN,Chang TY,Tan VH,Kuo L,Wu CI,Liu CM,Vicera JJB,Chen CC,Chin CG,Liu SH,Cheng WH,Chou CY,Lugtu IC,Liu CH,Chen SA

doi

10.1016/j.hrthm.2019.11.018

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

584-591

issue

4

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(19)31030-6

journal_volume

17

pub_type

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