| Lack of uniform progression of endocardial scar in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy and ventricular tachycardia. | |
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MedLine Citation:
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PMID: 20558846 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The endocardial substrate for ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is thought to be caused by a progressive degenerative process. Many clinical decisions and treatment plans are guided by this pathophysiologic assumption, but the extent of progression of macroscopic endocardial scar and right ventricular (RV) dilatation have not been assessed. METHODS AND RESULTS: Eleven patients with ARVD/C and ventricular tachycardia had 2 detailed sinus rhythm electroanatomic endocardial voltage maps (average, 291+/-122 points per map; range, 114 to 558 points) performed a mean of 57 months apart (minimum, 9 months) as part of ventricular tachycardia ablation procedures. Voltage-defined scar (<1.5 mV) and RV volume were measured by area and volume measurement software and compared. Two of the 11 patients had a clear increase in scar area (47 cm(2); 32 cm(2)) confirmed by visual inspection. The remaining 9 (81%; 95% CI, 48% to 98%) patients had no increase (<10-cm(2) difference) in scar area between studies. In contrast, 10 of the 11 patients had a significant increase in RV volume, with an average increase of 24% (212+/-67 mL to 263+/-52 mL; P< or =0.01). CONCLUSIONS: In patients with ARVD/C and ventricular tachycardia, progressive RV dilatation is the rule, and rapid progression of significant macroscopic endocardial scar occurs in only a subset of patients. These results have important management implications, suggesting that efforts to prevent RV dilatation in this population are needed and that an aggressive substrate-based ablation strategy offers the potential to provide long-term ventricular tachycardia control. |
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Authors:
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Michael P Riley; Erica Zado; Rupa Bala; David J Callans; Joshua Cooper; Sanjay Dixit; Fermin Garcia; Edward P Gerstenfeld; Mathew D Hutchinson; David Lin; Vickas Patel; Ralph Verdino; Francis E Marchlinski |
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Publication Detail:
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Type: Journal Article Date: 2010-06-17 |
Journal Detail:
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Title: Circulation. Arrhythmia and electrophysiology Volume: 3 ISSN: 1941-3084 ISO Abbreviation: Circ Arrhythm Electrophysiol Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-18 Completed Date: 2010-09-20 Revised Date: 2012-02-03 |
Medline Journal Info:
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Nlm Unique ID: 101474365 Medline TA: Circ Arrhythm Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 332-8 Citation Subset: IM |
Affiliation:
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Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Arrhythmogenic Right Ventricular Dysplasia / complications, pathology, surgery* Catheter Ablation* Cicatrix / etiology, pathology* Electrocardiography Electrophysiologic Techniques, Cardiac Endocardium / pathology* Female Humans Hypertrophy, Right Ventricular / etiology, pathology, prevention & control* Male Middle Aged Recurrence Reoperation Tachycardia, Ventricular / etiology, pathology, surgery* Time Factors Treatment Outcome Wound Healing* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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