Jeroen Venlet1, Sebastiaan R D Piers1, Jan D H Jongbloed2, Alexander F A Androulakis1, Yoshihisa Naruse1, Dennis W den Uijl1, Gijsbert F L Kapel1, Marta de Riva1, J Peter van Tintelen3, Daniela Q C M Barge-Schaapveld4, Martin J Schalij1, Katja Zeppenfeld5. 1. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 2. Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 3. Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 4. Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands. 5. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: k.zeppenfeld@lumc.nl.
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.
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.
Authors: Nicola Tarantino; Domenico G Della Rocca; Nicole S De Leon De La Cruz; Eric D Manheimer; Michele Magnocavallo; Carlo Lavalle; Carola Gianni; Sanghamitra Mohanty; Chintan Trivedi; Amin Al-Ahmad; Rodney P Horton; Mohamed Bassiouny; J David Burkhardt; G Joseph Gallinghouse; Giovanni B Forleo; Luigi Di Biase; Andrea Natale Journal: Medicina (Kaunas) Date: 2021-02-26 Impact factor: 2.430
Authors: Julia Martínez-Solé; María Sabater-Molina; Aitana Braza-Boïls; Juan J Santos-Mateo; Pilar Molina; Luis Martínez-Dolz; Juan R Gimeno; Esther Zorio Journal: Front Cardiovasc Med Date: 2021-10-18
Authors: Utku Gülan; Ardan Muammer Saguner; Deniz Akdis; Alexander Gotschy; Felix C Tanner; Sebastian Kozerke; Robert Manka; Corinna Brunckhorst; Markus Holzner; Firat Duru Journal: Sci Rep Date: 2019-01-14 Impact factor: 4.379