Diagnostic Value of Isoproterenol Testing in Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

Background-Although the Task Force Criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) have recently been updated, the diagnosis remains challenging in the early stages. .4 years, 6 additional patients met diagnostic criteria for ARVC. Importantly, initial isoproterenol testing was positive in 6 of 6 (100%) of these patients. Survival free from ARVC diagnosis was significantly lower in the positive isoproterenol group than in the negative isoproterenol group (P<0.0001, exact log-rank test). Conclusions-Ventricular arrhythmogenicity during isoproterenol testing is highly sensitive (sensitivity, 91.4%) for the diagnosis of ARVC, particularly in its early stages. (Circ Arrhythm Electrophysiol. 2014;7:590-597.)

Characterization of the Left-Sided Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy

“…In the present study, arrhythmogenicity was assessed from 12-lead ECG recordings at baseline and during isoproterenol testing. The rationale to use isoproterenol testing was that the ARVC substrate is known to show explosive response to isoproterenol, 34 and we hypothesized that an increased sensitivity would be of value to detect left-sided arrhythmias, which were expected to be less frequent when compared with right-sided arrhythmias. As expected, our results show that right-sided PVCs are more frequent than left-sided PVCs in ARVC although left-sided PVCs are more frequent in patients with LV involvement on imaging than in those without.…”

Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes

“…Thus, treadmill testing can reveal VT/ 113 In another study, the evaluation of the arrhythmic potential during very high dose isoproterenol infusion was sensitive for diagnosis of early forms of ARVC/D. 114 …”

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy – Three Decades of Progress –

“…23, 24 In a recent study, a total of 412 consecutive patients referred for evaluation of PVCs or ARVD/C underwent this test and 35 of them had been diagnosed with ARVD/C based on the revised 2010 TFC. The isoproterenol infusion consisted of intravenous administration of very high dose (45 mcg/min) isoproterenol for 3 min.…”

“…And third, high-dose isoproterenol results in the triggering of VT in patients with ARVD/C. 23, 24 Angiotensinconverting enzyme (ACE) inhibitors are also advised for most patients with ARVD/C and especially those with evidence of significant disease. There are no published trials in patients with ARVD/C, but there is a wealth of data supporting the role of ACE in a broader population of patients with cardiomyopathy.…”