title: Electrocardiographic predictors of electroanatomic scar size in arrhythmogenic right ventricular cardiomyopathy: implications for arrhythmic risk stratification.
abstract: BACKGROUND
  The extent of right ventricular (RV) electroanatomic scar (EAS) detected by endocardial voltage mapping (EVM) is a powerful invasive predictor of arrhythmic outcome in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Electrocardiogram (ECG) and signal-averaged ECG are noninvasive tools of established clinical value for the diagnosis of electrical abnormalities in ARVC. This study was designed to assess the role of ECG and SAECG abnormalities for noninvasive estimation of the extent and regional distribution of RV-EAS and prediction of scar-related arrhythmic risk.
  
  
  RESULTS
  The study population included 49 consecutive patients (38 males, median age 35 years) with a definite diagnosis of ARVC and an abnormal EVM by CARTO system. At univariate analysis, the presence of epsilon waves, the degree of RV dilation, the severity of RV dysfunction, and the extent of negative T waves correlated with RV-EAS% area. Normal T-waves were associated with a median RV-EAS% area of 4.9% (4.5-6.4), negative T waves in V1-V3 of 22.0% (8.5-30.6), negative T waves in V1-V3 extending to lateral precordial leads (V4-V6) of 26.8% (11.5-35.2), and negative T waves in both precordial (V2-V6) and inferior leads of 30.2% (24.8-33.0) (P < 0.001). At multivariate analysis, the extent of negative T waves remained the only independent predictor of RV-EAS% area (B = 4.4, 95%CI 1.3-7.4, P = 0.006) and correlated with the arrhythmic event-rate during follow-up (P = 0.03).
  
  
  CONCLUSIONS
  In patients with ARVC, the extent of negative T-waves across 12-lead ECG allows noninvasive estimation of the amount of RV-EAS and prediction of EAS-related arrhythmic risk.
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elmaghawry
authors.forename: Maria
authors.initials: M
authors.lastname: Silvano
authors.forename: Martina Perazzolo
authors.initials: MP
authors.lastname: Marra
authors.forename: Alice
authors.initials: A
authors.lastname: Niero
authors.forename: Kim
authors.initials: K
authors.lastname: Nguyen
authors.forename: Ilaria
authors.initials: I
authors.lastname: Rigato
authors.forename: Barbara
authors.initials: B
authors.lastname: Bauce
authors.forename: Cristina
authors.initials: C
authors.lastname: Basso
authors.forename: Gaetano
authors.initials: G
authors.lastname: Thiene
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
mesh_terms: D000200:Action Potentials; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D002921:Cicatrix / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology; D016278:Ventricular Function, Right
keywords: T-wave; arrhythmogenic right ventricular cardiomyopathy; electroanatomic mapping; electrocardiogram; sudden death; ventricular arrhythmias