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Heart 1998;79:388-393 ( April )
a Department of Cardiology, University
Hospital of Ghent, De Pintelaan 185, B-9000 Ghent, Belgium, b Department of Pathology, University
Hospital of Ghent
Correspondence to: Prof Dr Jordaens.
Accepted for publication 11 December 1997
Objective
To study differences between repetitive
monomorphic ventricular tachycardia (RMVT) of right ventricular origin,
and ventricular tachycardia in arrhythmogenic right ventricular
dysplasia (ARVD).
PatientsConsecutive groups with RMVT (n = 15)
or ARVD (n = 12), comparable for age and function.
MethodsAnalysis of baseline, tachycardia, and
signal averaged ECGs, clinical data, and right endomyocardial biopsies.
Pathological findings were related to regional depolarisation (QRS
width) and repolarisation (QT interval, QT dispersion).
ResultsThere was no difference in age, ejection
fraction, QRS width in leads I, V1, and V6, and QT indices. During
ventricular tachycardia, more patients with ARVD had a QS wave in V1
(p < 0.05). There were significant differences for unfiltered QRS,
filtered QRS, low amplitude signal duration, and the root mean square
voltage content. In the absence of bundle branch block, differences
became non-significant for unfiltered and filtered QRS duration. Mean (SD) percentage of biopsy surface differed between RMVT and ARVD: normal myocytes (74(3.4)% v 64.5(9.3)%; p < 0.05);
fibrosis (3(1.7)% v 8.9(5.2)%; p < 0.05). When all
patients were included, there were significant correlations between
fibrosis and age (r = 0.6761), and fibrosis and QRS
width (r = 0.5524 for lead I; r = 0.5254 for lead V1; and r = 0.6017 for lead V6).
ConclusionsThe ECG during
tachycardia and signal averaging are helpful in discriminating between
ARVD and RMVT patients. There are differences in the proportions of
normal myocytes and fibrosis. The QRS duration is correlated with the
amount of fibrous tissue in patients with ventricular tachycardia of
right ventricular origin.
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