Abstract 2770: ECG Inferior Lead Abnormalities in Arrhythmogenic Right Ventricular Dysplasia
Arrhythmogenic Right Ventricular Dysplasia (ARVD) primarily affects the RV. Diagnostic Task Force Criteria (TFC) use the right precordial leads V1–3. However, diagnostic contribution of inferior leads II, III and aVF, reflecting the frequently affected subtricuspid area and possibly LV involvement is unknown. Analysis of depolarization/repolarization abnormalities (Δdep/Δrep) in leads II, III and aVF in ARVD and relationship to disease localization and VT. We studied 45 ARVD patients (pts) fulfilling the TFC, plus 30 of their family members (fam) with ARVD-predisposition due to plakophilin2 (PKP2) mutations and 27 controls with idiopathic VT from RV outflow tract. Parameters measured:
Δdep: epsilon waves, QRS>110ms, terminal activation duration (from nadir S to end of all depolarization) ≥55ms
Δrep: T wave inversion
spontaneous VT: morphology and frontal plane axis and
RV + LV structure: a- or dyskinesia in different segments or diffuse dilatation on echo or MRI.
Measurements on Δdep/Δrep were performed in sinus rhythm in leads V1–3 and II, III and aVF while off drugs and pre-ablation. All pts, fam and 15/27 controls were screened for PKP2 mutations. Table 1⇓. ARVC pts with Δdep inferior had more TFC points than pts without (major=2, minor =1 point; 6±1 vs 5±1; P=.028) but groups were similar in all other categories. The same counted for pts with vs without Δrep inferior. Δdep and Δrep were uninfluenced by age, sex or PKP2 mutations. All but 1 pts with Δdep inferior also had Δdep in V1–3, and all but 2 with Δrep in II, III, aVF had negative T waves in V1–3. The 2 fam with VT from RVOT were also 2/3 fam with Δdep and T wave inversion in III + aVF. Altered depolarization and repolarization in inferior leads occur specifically in ARVD pts, particularly in more severe cases, irrespective of structural abnormalities or VT axis. Sensitivity of abnormalities in V1–3 is high and adding II, III, aVF in TFC has limited additional value to ARVD diagnosis.