Abstract 15922: Electrocardiographic Analysis on the Progression of Arrhythmogenic Right Ventricular Cardiomyopathy
Background: Recent studies supported that the progression of arrhythmogenic right ventricular cardiomyopathy (ARVC) can be divided into 4 phases; concealed, right ventricular (RV) failure, left ventricular (LV) failure, and diffuse phase. However, the natural history of ARVC patients is still not fully investigated.
Methods: We classified 91 ARVC patients (73 males and mean age of 47±14.4 yr) into the following four patterns of disease expression according to the anatomical feature analyzed by CT, MRI or RI image. Concealed phase was defined as normal LVEDV and RVEDV, more than 45% of LVEF and more than 25% of RVEF. RV failure phase was defined as enlarged RVEDV or ≦25% of RVEF. LV failure phase had enlarged LVEDV or ≦45% of LVEF. Diffuse phase was defined as enlarged or reduced EF in both ventricular. We evaluated the relation between electrocardiographic characteristics at the admission and the disease progression during the follow-up period.
Results: At the first admission, 49 patients (54%) was diagnosed as the concealed phase, 26 patients (29%) of RV failure, 9 patients (10%) of LV failure, and 7 patients (8%) of diffuse phase. During the follow-up period of 8.6±6.7 years, there were significant differences in all cause death (p < 0.0001) and hospitalization due to heart failure (p = 0.001) among each phase. Interestingly, there were no significant differences in VT/VF episodes during the follow-up period. Comparable data of anatomical feature was obtained in 20 of 91 patients. Disease phase was deteriorated in 45% of patients during the follow-up period. In the evaluation of 12-ECG, number of leads showing epsilon wave, negative T wave, QRS prolongation, and fragmented electrogram were associated with right ventricular dysfunction.
Conclusion: Clinicopathological feature of ARVC has progressed more advanced phase during the long-term follow-up. VT/VF was observed from concealed phase, but other cardiovascular events were more observed in the progressive phase. The progression of depolarization abnormality on the surface ECG was related to the disease progression of ARVC.
- © 2013 by American Heart Association, Inc.