Document Detail

Malignant Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy with a Normal 12-Lead Electrocardiogram: A Rare but Under Recognized Clinical Entity.
MedLine Citation:
PMID:  23816439     Owner:  NLM     Status:  Publisher    
BACKGROUND: In Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C), a normal electrocardiogram (ECG) is considered reassuring. However, some ARVD/C patients with ventricular arrhythmias have a normal ECG.
OBJECTIVES: 1) To estimate how often ARVD/C patients with ventricular arrhythmias have a normal ECG during sinus rhythm; and 2) To provide a clinical profile of these patients.
METHODS: We included 145 ARVD/C patients with a documented sustained ventricular arrhythmia. Conventional 12-lead sinus rhythm ECGs within six months of the event were reviewed for diagnostic Task Force Criteria (TFC). ECGs were classified as abnormal (≥1 TFC), non-specific (abnormal, no TFC) or normal. Cardiologic investigations within six months of the event were evaluated as per TFC in those with a non-specific or normal ECG.
RESULTS: The ECG was non-specific or normal in 17/145 (12%) subjects. Mean age of these patients was 41.3 ± 12.4 years, and 14 (82%) were male, comparable to those with an abnormal ECG. Most patients with a non-specific or normal ECG showed ≥1 TFC on Holter monitoring (n=9/10) and signal-averaged ECG (n=4/5), and all had non-sustained ventricular tachycardia recorded. Among 15 patients who underwent structural evaluation, 11 (73%) showed structural TFC (9 major, 2 minor).
CONCLUSION: Although most ARVD/C patients with arrhythmias have an abnormal ECG, a non-specific or normal ECG does not preclude ARVD/C diagnosis. All patients with a non-specific or normal ECG had alternative evidence of disease expression. These results alert the physician not to exclusively rely on ECG in ARVD/C, but to assess arrhythmic risk by comprehensive clinical evaluation.
Anneline S J M Te Riele; Cynthia A James; Aditya Bhonsale; Judith A Groeneweg; Christian F Camm; Brittney Murray; Crystal Tichnell; Jeroen F van der Heijden; Dennis Dooijes; Daniel P Judge; Richard N W Hauer; Harikrishna Tandri; Hugh Calkins
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-28
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-7-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Inc.
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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