Endomyocardial biopsy approach to patients with ventricular tachycardia with special reference to arrhythmogenic right ventricular dysplasia.

Right ventricular endomyocardial biopsies were performed in patients with repetitive ventricular tachycardia (VT; 8 patients) or ventricular premature beats (1 patient) which showed left bundle branch block morphology in electrocardiograms. These 9 male patients ranging in age from 21-55 years (mean 37.7 years) revealed enlargement and/or asynergy of the right ventricle in the ventriculogram. Randomly selected biopsied patients with dilated cardiomyopathy (DCM; 18 patients) and chronic right ventricular overloading (14 patients) who did not show the above-described arrhythmias served as controls. A histopathological analysis revealed advanced myocardial interstitial fibrosis associated with an increase in fatty tissue in 8 of the 9 patients (89%). Moreover, advanced hypertrophy of myocytes (grade 2 or more of our criteria), disarrangement of muscle bundles and endocardial thickening were prominent with incidences of 75%, 75% and 78%, respectively. Incidence of all findings was more pronounced in the ARVD group. Suggestiveness of post-myocarditic change in the biopsied specimen was high in 1 patient, showing a lower incidence (12%) than the DCM group (17%). From these results, we can conclude that different etiological factors may be the bases of these pathological changes. We believe that the presence of a large amount of fatty tissue within the myocardial tissue is an important element in the etiology of ventricular arrhythmias as it has also been recognized in patients with non-ARVD idiopathic ventricular tachycardia in our biopsy series.