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Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Electrocardiographic features of disease progression in arrhythmogenic right ventricular cardiomyopathy/dysplasia
Ardan M Saguner, Sabrina Ganahl, Andrea Kraus
1Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. firat.duru@usz.ch.
Insights
Arrhythmogenic right ventricular cardiomyopathy (ARVC) progresses over time, as shown by electrocardiogram (ECG) changes like epsilon waves. Repolarization abnormalities may resolve, but T-wave inversions are common in ARVC patients.
Area of Science:
- Cardiology
- Electrophysiology
- Genetic Cardiomyopathies
Background:
- Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a progressive heart muscle disease.
- Limited data exists on the clinical features and electrocardiographic (ECG) progression of ARVC/D.
- Understanding ECG changes during follow-up is crucial for managing ARVC/D.
Purpose of the Study:
- To assess 12-lead surface ECG changes during long-term follow-up in a large cohort of ARVC/D patients.
- To compare ECG findings with echocardiographic data.
- To evaluate the progressive nature of ARVC/D through ECG monitoring.
Main Methods:
- Systematic analysis of baseline and follow-up ECGs from 111 ARVC/D patients across three Swiss centers.
- Use of digital calipers by two blinded observers for ECG measurements.
- Correlation of ECG findings with transthoracic echocardiography results.
Main Results:
- Significant ECG progression observed in epsilon waves (14% to 31%, p=0.01) and QRS duration (111 ms to 114 ms, p=0.04) over a median 4-year follow-up.
- Repolarization abnormalities present at baseline disappeared in 6 patients, while epsilon waves persisted.
- Inferior T-wave inversions (36%) were associated with major repolarization abnormalities, RV involvement, and definite ARVC/D.
Conclusions:
- ARVC/D is generally progressive, with detectable changes on 12-lead surface ECG.
- Repolarization abnormalities may resolve during disease progression.
- Inferior T-wave inversions are a common finding in ARVC/D, indicating disease severity.
Background:
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is considered a progressive cardiomyopathy. However, data on the clinical features of disease progression are limited. The aim of this study was to assess 12-lead surface electrocardiographic (ECG) changes during long-term follow-up, and to compare these findings with echocardiographic data in our large cohort of patients with ARVC/D.
Methods:
Baseline and follow-up ECGs of 111 patients from three tertiary care centers in Switzerland were systematically analyzed with digital calipers by two blinded observers, and correlated with findings from transthoracic echocardiography.
Results:
The median follow-up was 4 years (IQR 1.9-9.2 years). ECG progression was significant for epsilon waves (baseline 14% vs. follow-up 31%, p = 0.01) and QRS duration (111 ms vs. 114 ms, p = 0.04). Six patients with repolarization abnormalities according to the 2010 Task Force Criteria at baseline did not display these criteria at follow-up, whereas in all patients with epsilon waves at baseline these depolarization abnormalities also remained at follow-up. T wave inversions in inferior leads were common (36% of patients at baseline), and were significantly associated with major repolarization abnormalities (p = 0.02), extensive echocardiographic right ventricular involvement (p = 0.04), T wave inversions in lateral precordial leads (p = 0.05), and definite ARVC/D (p = 0.05).
Conclusions:
Our data supports the concept that ARVC/D is generally progressive, which can be detected by 12-lead surface ECG. Repolarization abnormalities may disappear during the course of the disease. Furthermore, the presence of T wave inversions in inferior leads is common in ARVC/D.
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