Tachycardias of Right Ventricular Origin

Hoch, David; Rosenfeld, Lynda E.

doi:10.1016/s0733-8651(18)30260-1

Cited by 25 publications

(18 citation statements)

References 113 publications

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“…In addition, ventricular tachycardia can originate from the RV in a variety of disorders, such as arrhythmogenic RV dysplasia, RV myocardial infarction, left bundle-branch block, idiopathic ventricular tachycardia, or after surgical repair of congenital disease. 82 Although ventricular tachycardia that arises from the RV usually has a left bundle-branch block morphology, most ventricular tachycardia with this morphology arises from a paraseptal LV location. 82 …”

Section: Cardiac Rhythm and The Rvmentioning

confidence: 99%

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Right Ventricular Function in Cardiovascular Disease, Part I

et al. 2008

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I n 1616, Sir William Harvey was the first to describe the importance of right ventricular (RV) function in his seminal treatise, De Motu Cordis: "Thus the right ventricle may be said to be made for the sake of transmitting blood through the lungs, not for nourishing them." 1,2 For many years that followed, emphasis in cardiology was placed on left ventricular (LV) physiology, overshadowing the study of the RV. In the first half of the 20th century, the study of RV function was limited to a small group of investigators who were intrigued by the hypothesis that human circulation could function adequately without RV contractile function. 3 Their studies, however, were based on an open pericardial dog model, which failed to take into account the complex nature of ventricular interaction. In the early 1950s through the 1970s, cardiac surgeons recognized the importance of right-sided function as they evaluated procedures to palliate right-heart hypoplasia. Since then, the importance of RV function has been recognized in heart failure, RV myocardial infarction, congenital heart disease and pulmonary hypertension. More recently, advances in echocardiography and magnetic resonance imaging have created new opportunities for the study of RV anatomy and physiology.The goal of the present review is to offer a clinical perspective on RV structure and function. In the first part, we discuss the anatomy, physiology, aging, and assessment of the RV. In the second part, we discuss the pathophysiology, clinical importance, and management of RV failure. Anatomy of the RV Macroscopic Anatomy of the RVIn the normal heart, the RV is the most anteriorly situated cardiac chamber and lies immediately behind the sternum. In the absence of transposition of great arteries, the RV is delimited by the annulus of the tricuspid valve and by the pulmonary valve. As suggested by Goor and Lillehi, 4 the RV can be described in terms of 3 components: (1) the inlet, which consists of the tricuspid valve, chordae tendineae, and papillary muscles; (2) the trabeculated apical myocardium; and (3) the infundibulum, or conus, which corresponds to the smooth myocardial outflow region 4,5 (Figure 1). In the study of congenital heart disease, this division seems to be more practical than the traditional division of the RV into sinus and conus components. 5 Additionally, the RV can also be divided into anterior, lateral, and inferior walls, as well as basal, mid, and apical sections. 6 Three prominent muscular bands are present in the RV: the parietal band, the septomarginal band, and the moderator band. The parietal band and the infundibular septum make up the crista supraventricularis. 7 The septomarginal band extends inferiorly and becomes continuous with the moderator band, which attaches to the anterior papillary muscle. 7 When abnormally formed or hypertrophied, the septomarginal band can divide the ventricle into 2 chambers (double-chambered RV). 5 Another important characteristic of the RV is the presence of a ventriculoinfundibular fold that separate...

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Section: Cardiac Rhythm and The Rvmentioning

confidence: 99%

“…82 Although ventricular tachycardia that arises from the RV usually has a left bundle-branch block morphology, most ventricular tachycardia with this morphology arises from a paraseptal LV location. 82 …”

Section: Cardiac Rhythm and The Rvmentioning

confidence: 99%

Right Ventricular Function in Cardiovascular Disease, Part I

et al. 2008

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“…30,31 Ventricular tachycardia arising from the RV may occur in RVMI, PH, CHD, arrhythmogenic RV dysplasia, and idiopathic RV outflow tract tachycardia. 31,32 In patients with CHD, ventriculotomy and/or patching for certain type of ventricular defects are associated with a greater risk of developing ventricular tachycardia. 31 Sinus node dysfunction and conduction blocks also may contribute to exercise intolerance and hemodynamic instability in patients with RV dysfunction (Table 3).…”

Section: Arrhythmias and Sudden Death In Rv Diseasementioning

confidence: 99%

“…The clinical picture of Uhl's anomaly is dominated by congestive HF, which may result in death in infancy. 32 …”

Section: Arrhythmogenic Rv Dysplasia and Uhl's Anomalymentioning

confidence: 99%

Right Ventricular Function in Cardiovascular Disease, Part II

et al. 2008

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R ight ventricular (RV) function may be impaired in pulmonary hypertension (PH), congenital heart disease (CHD), and coronary artery disease and in patients with left-sided heart failure (HF) or valvular heart disease. In recent years, many studies have demonstrated the prognostic value of RV function in cardiovascular disease. In the past, however, the importance of RV function has been underestimated. This perception originated from studies on openpericardium dog models and from the observation that patients may survive without a functional subpulmonary RV (Fontan procedure). In the 1940s, studies using openpericardium dog models showed that cauterization of the RV lateral wall did not result in a decrease in cardiac output or an increase in systemic venous pressure. 1-3 As was later demonstrated, the open-pericardium model did not take into account the complex nature of ventricular interaction. In 1982, Goldstein and colleagues 2 showed that RV myocardial infarction (RVMI) in a closed-chest dog model led to significant hemodynamic compromise. These findings were further supported by clinical studies demonstrating an increased risk of death, arrhythmia, and shock in patients with RVMI. 4 The study of the RV is a relatively young field. In 2006, the National Heart, Lung, and Blood Institute identified RV physiology as a priority in cardiovascular research. 5 The goal of this review is to present a clinical perspective on RV physiology and pathobiology. In the first article of the series, the anatomy, physiology, embryology, and assessment of the RV were discussed. In this second part, we discuss the pathophysiology, clinical importance, and management of RV failure.

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“…In contrast, right ventricular outflow tract tachycardia in the setting of a normal heart has a more benign prognosis, at least in the adult [6]. The prognosis for RVOT tachycardia presenting in childhood is not well described and the risk of degeneration to a more malignant ventricular rhythm cannot be predicted.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Catheter Ablation of Right Ventricular Outflow Tract Tachycardia in a Preschooler

1999

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A 3-year-old girl presented with a febrile illness complicated by right ventricular outflow tract tachycardia, which persisted after resolution of the presumed viral infection. The tachycardia was intermittent, but was significantly exacerbated by exercise. Radiofrequency ablation (RFA) of the ectopic focus was successfully performed and the child remains free of tachycardia 12 months later. A review of the literature suggests that RFA in children is increasingly seen as a safe and convenient option for the treatment of supraventricular tachycardia, whereas the management of ectopic ventricular tachycardia in pediatric practice has not been well defined.

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Tachycardias of Right Ventricular Origin

Cited by 25 publications

References 113 publications

Right Ventricular Function in Cardiovascular Disease, Part I

Right Ventricular Function in Cardiovascular Disease, Part I

Right Ventricular Function in Cardiovascular Disease, Part II

Radiofrequency Catheter Ablation of Right Ventricular Outflow Tract Tachycardia in a Preschooler

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