title: Exercise-induced normalization of right precordial negative T waves in arrhythmogenic right ventricular cardiomyopathy.
abstract: Negative T waves (NTWs) in right precordial leads (V₁ to V₃) may be observed on the electrocardiogram (ECG) of healthy subjects but can also represent the hallmark of an underlying arrhythmogenic right ventricular cardiomyopathy (ARVC). It has been a consistent observation that NTWs usually become upright with exercise in healthy subjects without underlying heart disease. No systematic study has evaluated exercise-induced changes of NTWs in ARVC. We assessed the prevalence and relation to the clinical phenotype of exercise-induced right precordial NTWs changes in 35 patients with ARVC (19 men, mean age 22.2 ± 6.2 years). Forty-one healthy subjects with right precordial NTWs served as controls. At peak of exercise (mean power 149 ± 43 W, mean heart rate 83.6 ± 12.6% of target), NTWs persisted in 3 patients with ARVC (9%), completely normalized in 12 (34%), and partially reverted in 20 (57%). Patients with ARVC with or without NTWs normalization showed a similar clinical phenotype. The overall prevalence of right precordial T waves changes during exercise (normalization plus partial reversal) did not differ between patients with ARVC and controls (92% vs 88%, p = 1.0), whereas there was a statistically nonsignificant trend toward a greater prevalence of complete normalization in controls (56% vs 34%, p = 0.06). In conclusion, our study demonstrated that right precordial NTWs partially or completely revert with exercise in most patients with ARVC, and NTWs normalization is unrelated to the clinical phenotype. Exercise-induced NTWs changes are inaccurate in differentiating between ARVC patients and benign repolarization abnormalities.
authors: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors: Alessandro
authors: A
authors: Zorzi
authors: Mohamed
authors: M
authors: ElMaghawry
authors: Ilaria
authors: I
authors: Rigato
authors: Fernando
authors: F
authors: Cardoso Bianchini
authors: Georgiane
authors: G
authors: Crespi Ponta
authors: Pierantonio
authors: P
authors: Michieli
authors: Federico
authors: F
authors: Migliore
authors: Martina
authors: M
authors: Perazzolo Marra
authors: Barbara
authors: B
authors: Bauce
authors: Cristina
authors: C
authors: Basso
authors: Maurizio
authors: M
authors: Schiavon
authors: Gaetano
authors: G
authors: Thiene
authors: Sabino
authors: S
authors: Iliceto
authors: Domenico
authors: D
authors: Corrado
mesh_terms: D000293:Adolescent; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D013177:Sports / Q000502:physiology; D055815:Young Adult