Isolated Subepicardial Right Ventricular Outflow Tract Scar in Athletes With Ventricular Tachycardia.
J Am Coll Cardiol
; 69(5): 497-507, 2017 Feb 07.
Article
em En
| MEDLINE
| ID: mdl-28153106
ABSTRACT
BACKGROUND:
High-level endurance training has been associated with right ventricular pathological remodeling and ventricular tachycardia (VT). Although overlap with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been suggested, the arrhythmogenic substrate for VTs in athletes is unknown.OBJECTIVES:
The goal of this study was to evaluate whether electroanatomic scar patterns related to sustained VT can distinguish exercise-induced arrhythmogenic remodeling from ARVC and post-inflammatory cardiomyopathies.METHODS:
In 57 consecutive patients (mean age 48 ± 16 years; 83% male) undergoing catheter ablation for scar-related right ventricular VT, 2 distinct scar distributions were identified 1) scars involving the subtricuspid right ventricle in 46 patients (group A); and 2) scars restricted to the anterior subepicardial right ventricular outflow tract in 11 patients (group B).RESULTS:
Definite ARVC or post-inflammatory cardiomyopathy was diagnosed in 40 (87%) of 46 group A patients but was not diagnosed in any patients in group B. All group B patients underwent intensive endurance training for a median of 15 h/week (interquartile range [IQR] 10 to 20 h/week) for a median of 13 years (IQR 10 to 18 years). The cycle lengths of scar-related VTs were significantly faster in group B patients (257 ± 34 ms vs. 328 ± 72 ms in group A; p = 0.003). Catheter ablation resulted in complete procedural success in 10 (91%) of 11 group B patients compared with 26 (57%) of 46 group A patients (p = 0.034). During a median follow-up of 27 months (IQR 6 to 62 months), 50% of group A patients but none of the group B patients had a VT recurrence.CONCLUSIONS:
This study describes a novel clinical entity of an isolated subepicardial right ventricular outflow tract scar serving as a substrate for fast VT in high-level endurance athletes that can be successfully treated by ablation. This scar pattern may allow distinguishing exercise-induced arrhythmogenic remodeling from ARVC and post-inflammatory cardiomyopathy.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Resistência Física
/
Esportes
/
Obstrução do Fluxo Ventricular Externo
/
Taquicardia Ventricular
/
Remodelação Ventricular
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article