Utility of a combined Signal-Averaged electrocardiogram and QT dispersion algorithm in identifying arrhythmogenic right ventricular dysplasia in patients with tachycardia of right ventricular origin

      Signal-averaged electrocardiography is used to detect the presence of “late potentials,” which reflect slowed propagation in the myocardium, leading to delayed ventricular activation.
      • Simson M.B.
      Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction.
      ,
      • El-Sherif N.
      • Gomes J.A.C.
      • Restivo M.
      • Mehra R.
      Late potential and arrhythmogenesis.
      Abnormalities of the signal-averaged electrocardiogram have been reported in 47% to 100% in patients with arrhythmic right ventricular dysplasia (ARVD)
      • Nasir K.
      • Rutberg J.
      • Tandri H.
      • Tichnell C.
      • Spevak P.
      • Crossan J.
      • Baughman K.L.
      • Kasper E.K.
      • Tomaselli G.F.
      • Berger R.
      • Calkins H.
      Filtered QRS duration predicts inducibility of ventricular tachycardia in arrhythmogenic right ventricular dysplasia.
      ,
      • Blomstrom-Lundqvist C.
      • Hirsh I.
      • Oslon B.
      • Edvardsson N.
      Quantitative analysis of the signal-averaged QRS with arrhythmogenic right ventricular dysplasia.
      ,
      • Nava A.
      • Folino F.
      • Bauce B.
      • Turrini P.
      • Buja G.F.
      • Daliento L.
      • Thiene G.
      Signal-averaged electrocardiogram in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular arrhythmias.
      but are generally not observed in patients with idiopathic ventricular tachycardia (VT).
      • Buxton A.E.
      • Waxman H.L.
      • Marchlinski F.E.
      • Simpson M.B.
      • Cassidy D.
      • Josephson M.E.
      Right ventricular tachycardia clinical and electrophysiological characteristics.
      ,
      • Mehta D.
      • McKenna W.J.
      • Ward D.E.
      • Davis M.J.
      • Camm A.J.
      Significance of signal-averaged electrocardiography in relation to right ventricular endomyocardial biopsy in patients with ventricular tachycardia without clinically apparent heart disease.
      Increased QT dispersion (QTd) is a measure of the inhomogeneity of ventricular repolarization, and has been found to be a predictor of major arrhythmic events and sudden cardiac death in patients with structural heart diseases,
      • Perkiomaki J.
      • Koistinen M.
      • Yli-Mayry S.
      • Huikuri H.
      Dispersion of QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous infarction.
      ,
      • Pye M.
      • Quinn A.
      • Cobbe A.
      QT interval dispersion a non-invasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias?.
      including ARVD.
      • Turrini P.
      • Corrado D.
      • Basso C.
      • Nava A.
      • Bauce B.
      • Thiene G.
      Dispersion of ventricular depolarization-repolarization a noninvasive marker for risk stratification in arrhythmogenic right ventricular cardiomyopathy.
      QTd is not prolonged in those with idiopathic VT compared with that in normal persons.
      • Sakabe K.
      • Ikeda T.
      • Kawase A.
      • Kumagai K.
      • Sakai T.
      • Tezuka N.
      • Takami M.
      • Nakae T.
      • Sakata T.
      • Noro M.
      • et al.
      Lack of noninvasive markers of ventricular repolarization inhomogeneity in patients with idiopathic ventricular tachyarrhythmias.
      The purpose of this study was to evaluate the predictive ability of a combined algorithm using the signal-averaged electrocardiogram and QTd in identifying ARVD among patients presenting with VT of right ventricular origin.
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