Right bundle branch block ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy more commonly originates from the right ventricle: Criteria for identifying chamber of origin

Marchlinski, Dylan F.; Tschabrunn, Cory M.; Zado, Erica S.; Marchlinski, Francis E.

doi:10.1016/j.hrthm.2020.08.016

Cited by 13 publications

(16 citation statements)

References 17 publications

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“…An available mapping and catheter ablation study demonstrated that a RBBB VT morphology on standard ECG may be inadequate for identifying the LV origin and, thus, diagnosing a LV disease involvement. 52 Two thirds of RBBB VT in this series of patients with ACM originated from the apical/inferior septal regions of a dilated RV and showed an early transition to a negative QRS by V3. Only 17% of RBBB VT actually arose from the LV and characteristically exhibited a broad positive QRS in V1, lack of precordial QRS transition, and rightward QRS axis.…”

Section: The 2020 International Criteria For LV Phenotypementioning

confidence: 64%

Evolving Diagnostic Criteria for Arrhythmogenic Cardiomyopathy

Corrado

Zorzi

Cipriani

et al. 2021

JAHA

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Criteria for diagnosis of arrhythmogenic cardiomyopathy (ACM) were first proposed in 1994 and revised in 2010 by a Task Force. Although the Task Force criteria demonstrated a good accuracy for diagnosis of the original right ventricular phenotype (arrhythmogenic right ventricular cardiomyopathy), they lacked sensitivity for identification of the expanding phenotypic spectrum of ACM, which includes left‐sided variants and did not incorporate late‐gadolinium enhancement findings by cardiac magnetic resonance. The 2020 International criteria (“Padua criteria”) have been developed by International experts with the aim to improve the diagnosis of ACM by providing new criteria for the diagnosis of left ventricular phenotypic features. The key upgrade was the incorporation of tissue characterization findings by cardiac magnetic resonance for noninvasive detection of late‐gadolinium enhancement/myocardial fibrosis that are determinants for characterization of arrhythmogenic biventricular and left ventricular cardiomyopathy. The 2020 International criteria are heavily dependent on cardiac magnetic resonance, which has become mandatory to characterize the ACM phenotype and to exclude other diagnoses. New criteria regarding left ventricular depolarization and repolarization ECG abnormalities and ventricular arrhythmias of left ventricular origin were also provided. This article reviews the evolving approach to diagnosis of ACM, going back to the 1994 and 2010 International Task Force criteria and then grapple with the modern 2020 International criteria.

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Section: The 2020 International Criteria For LV Phenotypementioning

confidence: 64%

Evolving Diagnostic Criteria for Arrhythmogenic Cardiomyopathy

Corrado

Zorzi

Cipriani

et al. 2021

JAHA

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“…In our recently published European Survey on ACM involving 954 ACM patients with at least 1 documented episode of sustained VT, we found that 72 (7.5%) of these patients exhibited a RBBB morphology during VT, which suggests a LV arrhythmia origin. 4 However, recent data from Marchlinski et al 5 suggest that up to half of RBBB-VT cases may originate from the inferior RV.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia

Laredo¹,

Tovia-Brodie

Milman

et al. 2023

EP Europace

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Aims Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data. Methods and results From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available. Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). T-wave inversion (TWI) was equally frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV. Conclusions In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants.

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“…In our study, superior axis RBBB-VTs were the predominant RBBB-VT type. In a recent work from Marchlinski et al 5 patients, 17% had RBBB-VT, and surprisingly, 58% of the RBBB-VTs had a RV origin from the inferior RV wall. RV origin was assessed by activation or pace-mapping at the RV endo-or epicardium.…”

Section: Superior-axis Right Bundle Branch Block-ventricular Tachycar...mentioning

confidence: 90%

“…Putative LV site of origin was estimated based on the VT axis using the methodology established by Andreu et al 10 RBBB-VTs with a superior axis were assessed according to the description from Marchlinski et al 5 for a possible inferior RV origin. 5 Superior-axis RBBB-VTs with an early precordial R-wave transition (≤V3) were classified as consistent with the description from Marchlinski et al 5 Electro-anatomic mapping…”

Section: Right Bundle Branch Block-ventricular Tachycardia Electrocar...mentioning

confidence: 99%

“…3 In our recently published European Survey on ACM involving 954 ACM patients with at least 1 documented episode of sustained VT, we found that 72 (7.5%) of these patients exhibited a RBBB morphology during VT, which suggests a LV arrhythmia origin. 4 However, recent data from Marchlinski et al 5 suggest that up to half of RBBB-VT cases may originate from the inferior RV.…”

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confidence: 99%

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