title: Electrocardiographic comparison of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy and right ventricular outflow tract tachycardia.
abstract: OBJECTIVE
  The purpose of this study was to evaluate whether electrocardiographic characteristics of ventricular arrhythmias distinguish patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) from those with right ventricular outflow tract tachycardia (RVOT-VT).
  
  
  BACKGROUND
  Ventricular arrhythmias in RVOT-VT and ARVD/C-VT patients can share a left bundle branch block/inferior axis morphology.
  
  
  METHODS
  We compared the electrocardiographic morphology of ventricular tachycardia or premature ventricular contractions with left bundle branch block/inferior axis pattern in 16 ARVD/C patients with that in 42 RVOT-VT patients.
  
  
  RESULTS
  ARVD/C patients had a significantly longer mean QRS duration in lead I (150 ± 31 ms vs. 123 ± 34 ms, p = 0.006), more often exhibited a precordial transition in lead V(6) (3 of 17 [18%] vs. 0 of 42 [0%] with RVOT-VT, p = 0.005), and more often had at least 1 lead with notching (11 of 17 [65%] vs. 9 of 42 [21%], p = 0.001). The most sensitive characteristics for the detection of ARVD/C were a QRS duration in lead I of ≥120 ms (88% sensitivity, 91% negative predictive value). QRS transition at V(6) was most specific at 100% (100% positive predictive value, 77% negative predictive value). The presence of notching on any QRS complex had 79% sensitivity and 65% specificity of (55% positive predictive value, 85% negative predictive value). In multivariate analysis, QRS duration in lead I of ≥120 ms (odds ratio [OR]: 20.4, p = 0.034), earliest onset QRS in lead V(1) (OR: 17.0, p = 0.022), QRS notching (OR: 7.7, p = 0.018), and a transition of V(5) or later (OR: 7.0, p = 0.030) each predicted the presence of ARVD/C.
  
  
  CONCLUSIONS
  Several electrocardiographic criteria can help distinguish right ventricular outflow tract arrhythmias originating from ARVD/C compared with RVOT-VT patients.
authors.affiliation: Division of Cardiology, Electrophysiology Section, UCSF Medical Center, San Francisco California, USA.
authors.forename: Kurt S
authors.initials: KS
authors.lastname: Hoffmayer
authors.forename: Orlando N
authors.initials: ON
authors.lastname: Machado
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Marcus
authors.forename: Yanfei
authors.initials: Y
authors.lastname: Yang
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Johnson
authors.forename: Simon
authors.initials: S
authors.lastname: Ermakov
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Ulhas
authors.initials: U
authors.lastname: Pandurangi
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: David
authors.initials: D
authors.lastname: Cannom
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Gear
authors.forename: Crystal
authors.initials: C
authors.lastname: Tichnell
authors.forename: Young
authors.initials: Y
authors.lastname: Park
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Frank I
authors.initials: FI
authors.lastname: Marcus
authors.forename: Melvin M
authors.initials: MM
authors.lastname: Scheinman
mesh_terms: D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000503:physiopathology*; D002037:Bundle-Branch Block / Q000503:physiopathology; D004562:Electrocardiography; D006801:Humans; D016015:Logistic Models; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology*; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000503:physiopathology*; D018879:Ventricular Premature Complexes / Q000503:physiopathology