Author`s Reply.

To the Editor,

We would like to thank the authors of the paper entitled “Electrical storm might be the initial presentation of arrhythmogenic right ventricular cardiomyopathy” for their interest in our article published in Anatol J Cardiol 2015 (1). The authors suggested arrhythmogenic right ventricular cardiomyopathy (ARVC) among possible diagnoses for patients who presented with incessant ventricular tachycardia (VT). Firstly, the VT ECG’s presented by us highlighted the left ventricule (LV) as the source of arrhythmia and not consistent with epicardial VT. Sinus ECG’s did not show the features of ARVC. None of the patients had family history for sudden death. Our patient group was defined as ischemic cardiomyopathy after we performed coronary angiograms at our center or if they had undergone the same at another hospital and was documented to us. If they underwent CABG surgery, they were also included in that group. We also conducted nuclear imaging studies for some patients. Prior to ablation, all of the patients underwent echocardiography, which was performed by experienced physicians, and none of the patients were reported as having abnormalities recalling ARVD. During the electrophysiological study, mapping demonstrated that an abnormal electrogram and scar regions were present in the LV. As known, ARVD-related VT’s generally have substrates at the epicardium, and our unipolar recording above 8.27 mV endocardially. We defined LAVA’s, late potentials, and diastolic potentials in LV, and all these locations checked with pacing to delineate long stimulus to QRS to define slow conduction zones. Our pace mapping inside LV were also matched with clinical VTs. Procedures that were performed during VT were entrained with concealed fusion, and post-pacing intervals showed that re-entry circuits were present in LV. During follow up, none of our patients underwent cardiac transplantation for incessant VT. However, the issue raised by the authors is important, and one should keep in mind the differential diagnoses for patients presented with the electrical storm.