title: The ventricular ectopic QRS interval (VEQSI): Diagnosis of arrhythmogenic right ventricular cardiomyopathy in patients with incomplete disease expression.
abstract: The ventricular ectopic QRS interval (VEQSI) has been shown to identify structural heart disease and predict mortality. In arrhythmogenic right ventricular cardiomyopathy (ARVC), early diagnosis is difficult using current methods, and life-threatening arrhythmias are common and difficult to predict.
  
  
  
  The purpose of this study was to assess the utility of ventricular ectopic indices including VEQSI in ARVC diagnosis.
  
  
  
  We studied 70 patients with ARVC [30 with definite disease (age 47 ± 12 years; 60% male), 40 with incomplete disease expression (age 44 ± 18 years; 44% male)], 116 healthy controls (age 40 ± 15 years; 56% male), and 26 patients with normal heart right ventricular outflow tract (RVOT) ectopy (age 46 ± 17 years; 27% male). The duration of the broadest ventricular ectopic beat during 12-lead Holter monitoring was recorded as VEQSI max.
  
  
  
  VEQSI max was associated with age and gender, but not with conducted QRS duration. Adjusted VEQSI max was greater in ARVC patients than in control groups. In healthy males (44.5 years), estimated VEQSI max was 163 ms (95% confidence interval [CI] 159-167 ms); in definite ARVC 212 ms (95% CI 206-217 ms); in incompletely expressed ARVC 204 ms (95% CI 199-210 ms); and in normal heart RVOT ectopy 171 ms (95% CI 165-178 ms). VEQSI max >180 ms had 98% sensitivity and specificity for diagnosis of ARVC (area under the curve 0.99, 95% CI 0.980-0.998). In our incompletely expressed ARVC patients, VEQSI max >180 ms identified 88% as affected.
  
  
  
  VEQSI max distinguishes ARVC patients, including those with incomplete disease expression, from healthy controls and patients with normal heart RVOT ectopy.
authors.affiliation: St. George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastiaenen
authors.affiliation: The Heart Hospital, University College London Hospitals NHS Trust, London, United Kingdom.
authors.forename: Antonis
authors.initials: A
authors.lastname: Pantazis
authors.affiliation: St. George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Hanney
authors.initials: H
authors.lastname: Gonna
authors.affiliation: Institute of Infection and Immunity, St. George's University of London, United Kingdom.
authors.forename: Irina
authors.initials: I
authors.lastname: Chis-Ster
authors.affiliation: National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Silvia
authors.initials: S
authors.lastname: Castelletti
authors.affiliation: Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom.
authors.forename: Velislav N
authors.initials: VN
authors.lastname: Batchvarov
authors.affiliation: St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Giulia
authors.initials: G
authors.lastname: Domenichini
authors.affiliation: University of Bologna Institute of Cardiology, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Coccolo
authors.affiliation: University of Bologna Institute of Cardiology, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: William J
authors.initials: WJ
authors.lastname: McKenna
authors.affiliation: St. George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom.
authors.forename: Elijah R
authors.initials: ER
authors.lastname: Behr
authors.affiliation: St. George's University Hospitals NHS Foundation Trust, London, United Kingdom. Electronic address: mark_m_gallagher@hotmail.com.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Gallagher
mesh_terms: D000328:Adult; D000367:Age Factors; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D042241:Early Diagnosis; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D006113:United Kingdom; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
keywords: Arrhythmogenic right ventricular cardiomyopathy; Implantable cardioverter-defibrillator; Sudden cardiac death; Ventricular ectopic QRS interval (VEQSI); Ventricular ectopic beat