title: Characterization of the Left-Sided Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy.
abstract: BACKGROUND
  The correlates of left ventricular (LV) substrate in arrhythmogenic right ventricular (RV) cardiomyopathy are largely unknown.
  
  
  RESULTS
  Thirty-two patients with arrhythmogenic RV cardiomyopathy (47±14 years; 6 women) were included. RV and LV dysplasia were defined from multidetector computed tomography and cardiac magnetic resonance imaging. Arrhythmias were characterized as right-sided or left-sided on 12-lead ECG recordings at baseline and during isoproterenol testing. In 14 patients, the imaging substrate was compared with voltage mapping and local abnormal ventricular activity. Imaging abnormalities were found in 32 (100%) and 21 (66%) patients on the RV and LV, respectively, intramyocardial fat on multidetector computed tomography being the most sensitive feature. LV involvement related to none of the Task Force criteria. Right-sided arrhythmias were more frequent than left-sided arrhythmias (P=0.003) although the latter were more frequent in case of LV involvement (P=0.02). The agreement between low voltage and fat on multidetector computed tomography was high on the RV when using either endocardial unipolar or epicardial bipolar data (κ=0.82 and κ=0.78, respectively) but lower on the LV (κ=0.54 for epicardial bipolar). LV local abnormal ventricular activity was found in all patients with LV involvement, and none of the others. The density of local abnormal ventricular activity within fat areas was similar between the RV and LV (P=0.57).
  
  
  CONCLUSIONS
  LV substrate is frequent in arrhythmogenic RV cardiomyopathy, but poorly identified by current diagnostic strategies. Left-sided arrhythmias are more frequent in case of LV involvement. LV fat hosts the same density of local abnormal ventricular activity as RV fat, but is less efficiently detected by voltage mapping. These results support the need for alternative diagnostic strategies to identify LV dysplasia.
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Benjamin
authors: B
authors: Berte
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Arnaud
authors: A
authors: Denis
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Sana
authors: S
authors: Amraoui
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Seigo
authors: S
authors: Yamashita
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Yuki
authors: Y
authors: Komatsu
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Xavier
authors: X
authors: Pillois
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Frédéric
authors: F
authors: Sacher
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Saagar
authors: S
authors: Mahida
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Jean-Yves
authors: JY
authors: Wielandts
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Jean-Marc
authors: JM
authors: Sellal
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Antonio
authors: A
authors: Frontera
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Nora
authors: N
authors: Al Jefairi
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Nicolas
authors: N
authors: Derval
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Michel
authors: M
authors: Montaudon
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: François
authors: F
authors: Laurent
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Mélèze
authors: M
authors: Hocini
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Michel
authors: M
authors: Haïssaguerre
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.).
authors: Pierre
authors: P
authors: Jaïs
authors: From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.). hcochet@wanadoo.fr.
authors: Hubert
authors: H
authors: Cochet
mesh_terms: D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
chemical_list: D000318:Adrenergic beta-Agonists; D007545:Isoproterenol
keywords: arrhythmias, cardiac; arrhythmogenic right ventricular dysplasia; catheter ablation; multidetector computed tomography; tachycardia, ventricular