Intracardiac echocardiography and electroanatomic mapping in diagnosis of arrhythmogenic right ventricular dysplasia.
A 48-year-old man with an episode of syncope and family history of sudden cardiac death was evaluated. The ECG showed negative T waves from V1 to V3 with evidence of epsilon-wave. Magnetic resonance imaging showed replacement with fibrofatty tissue in midapical regions of free wall of the right ventricle with dyskinesia. Transthoracic echocardiography revealed only mild enlargement of the middle right ventricular cavity. A programmed ventricular stimulation induced only an unsustained monomorphic ventricular tachycardia. Intracardiac echocardiography showed mild right ventricular enlargement and outflow dilatation (26 mm), microaneurysms with systolic bulging along the apical segment of the right ventricle. Bipolar voltage mapping, performed by the Carto system, detected a circumscribed low potential (<1.5 mV) area at the same level of the right ventricular apex. Cardiovascular imaging improves the detection of abnormal myocardial areas. Further studies are warranted to support this hypothesis.
Department of Cardiology, San Filippo Neri Hospital, Italy. sabinaficili@yahoo.it
Sabina
S
Ficili
Claudio
C
Pandozi
Maurizio
M
Russo
Serena
S
Dottori
Alessandro
A
Cina
Luigi
L
Natale
Carlo
C
Lavalle
Marco
M
Galeazzi
Massimo
M
Santini
D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004554:Electric Countershock / Q000295:instrumentation; D004562:Electrocardiography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013575:Syncope / Q000209:etiology; D056969:Voltage-Sensitive Dye Imaging