title: High prevalence of catecholamine-facilitated focal ventricular tachycardia in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.
abstract: BACKGROUND
  Exercise-related ventricular tachycardia (VT) and high burden of premature ventricular contractions (PVCs) are common in arrhythmogenic right ventricular dysplasia/cardiomyopathy. We hypothesized that VT in arrhythmogenic right ventricular dysplasia/cardiomyopathy shows a high degree of association with the PVC at baseline.
  
  
  RESULTS
  The study population included 16 consecutive arrhythmogenic right ventricular dysplasia/cardiomyopathy patients with recurrent VT who underwent catheter ablation. Median age of the patients was 27 years (range, 18-66) and 50% were men. All patients had frequent ectopy at baseline with a median PVC count of 7275 (range, 1353-19 084). During EP study, a total of 27 VTs were induced, of which 16 (59%) occurred during high-dose isoproterenol infusion. VT morphology was identical to the baseline PVCs in all the VTs induced during high-dose isoproterenol infusion. Focal ablation at the site of earliest activation and 12/12 pace map of the PVC eliminated the VT in all cases. Target site for focal ablation localized to scar border. Cumulative freedom from VT after ablation was 85.2% and 74.5% at 1 and 2 years, respectively, which was associated with a reduction in PVC count.
  
  
  CONCLUSIONS
  We report a high degree of association between PVCs at baseline and the VTs induced during catecholamine infusion. These VTs originated from the border region of scar most commonly in the right ventricular outflow tract and right ventricle basal regions. These findings highlight the importance of catecholamine challenge and PVC mapping, which can in turn facilitate ablation of the VT in arrhythmogenic right ventricular dysplasia/cardiomyopathy.
authors.affiliation: Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Binu
authors.initials: B
authors.lastname: Philips
authors.forename: Srinivasa
authors.initials: S
authors.lastname: Madhavan
authors.forename: Cynthia
authors.initials: C
authors.lastname: James
authors.forename: Crystal
authors.initials: C
authors.lastname: Tichnell
authors.forename: Brittney
authors.initials: B
authors.lastname: Murray
authors.forename: Matthew
authors.initials: M
authors.lastname: Needleman
authors.forename: Aditya
authors.initials: A
authors.lastname: Bhonsale
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Laurita
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists; D000328:Adult; D000368:Aged; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000453:epidemiology*; D015142:Baltimore / Q000453:epidemiology; D017115:Catheter Ablation; D018572:Disease-Free Survival; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007545:Isoproterenol; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult; D000098850:Polymorphic Catecholaminergic Ventricular Tachycardia
chemical_list: D000318:Adrenergic beta-Agonists; D007545:Isoproterenol