[Idiopathic right ventricular tachycardia or arrhythmogenic right ventricular tachycardia?].
METHODS
While cycling a 38-year-old man suddenly experienced palpitations associated with marked weakness. 90 min later his general practitioner, having diagnosed a ventricular tachycardia (VT) with a rate of 218/min, terminated it by a drug injection.


METHODS
Electrocardiography (ECG), echocardiography and biventricular cardiac catheterization with right ventricular contrast injection failed to provide any evidence of structural abnormality. However, ergometry and EPS with programmed ventricular stimulation induced VT of identical morphology (left bundle branch bloc [LBBB] with right axis deviation [RAD]).


METHODS
Idiopathic right-ventricular outflow tract tachycardia (IRVT) having been diagnosed, the patient was put on a maintenance dose of 50 mg/d atenolol. After 6 months without symptoms he again experienced several attacks of tachycardia. Resting ECG merely revealed an epsilon potential and negative T waves in V1-V3. Right ventricular contrast injection revealed inferolateral dyskinesia. EPS demonstrated both the known VT and a second, morphologically different one (LBBB with LAD). These findings indicated arrhythmogenic right-ventricular cardiomyopathy (ARCV). A cardioverter/defibrillator was implanted (ICD) and over the subsequent 8 months he had six episodes of VT which were quickly terminated by the ICD.


CONCLUSIONS
At first presentation of right-ventricular outflow tract tachycardia it is often not possible to differentiate between IRVT and arrhythmogenic RV cardiomyopathy. The two being significantly different in prognosis and treatment, follow-up monitoring is essential to establish the definitive diagnosis.
Kuhn
A
A
Herzzentrum, Klinik für Innere Medizin/Kardiologie, Universität Leipzig. kuhna@gmx.de
Kottkamp
H
H
Thiele
H
H
Schuler
G
G
Hindricks
G
G
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis*; D001262:Atenolol / Q000627:therapeutic use; D001642:Bicycling; D006328:Cardiac Catheterization; D017147:Defibrillators, Implantable; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000188:drug therapy; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D001262:Atenolol
Idiopathische rechtsventrikuläre Tachykardie oder arrhythmogene rechtsventrikuläre Kardiomyopathie?