Application of noninvasive signal-averaged electrocardiogram analysis in predicting the requirement of epicardial ablation in patients with arrhythmogenic right ventricular cardiomyopathy

Fa Po Chung, Chin Yu Lin, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Tze Fan Chao, Jo Nan Liao, Ting Yung Chang, Vern Hsen Tan, Ling Kuo, Cheng I. Wu, Chih Min Liu, Jennifer Jeanne B. Vicera, Chun Chao Chen, Chye Gen Chin, Shin Huei Liu, Wen Han Cheng, Ching Yao ChouIsaiah C. Lugtu, Ching Han Liu, Shih Ann Chen

Research output: Contribution to journalArticle

Abstract

Background: Signal-averaged electrocardiogram (SAECG) provides not only diagnostic information but also the prognostic implication of ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC). Objective: This study aimed to validate the role of SAECG in identifying arrhythmogenic substrates requiring an epicardial approach in ARVC. Methods: Ninety-one patients with a definite diagnosis of ARVC who underwent successful ablation for drug-refractory ventricular arrhythmia were enrolled and classified into 2 groups: group 1 who underwent successful ablation at the endocardium only and group 2 who underwent successful ablation requiring an additional epicardial approach. The baseline characteristics of patients and SAECG parameters were obtained for analysis. Results: Male predominance, worse right ventricular (RV) function, higher incidence of syncope, and depolarization abnormality were observed in group 2. Moreover, the number of abnormal SAECG criteria was higher in group 2 than in group 1. After a multivariate analysis, the independent predictors of the requirement of epicardial ablation included the number of abnormal SAECG criteria (odds ratio 2.8, 95% confidence interval 1.4–5.4; P =.003) and presence of syncope (odds ratio 11.7; 95% confidence interval 2.7–50.4; P =.001). In addition, ≥2 abnormal SAECG criteria were associated with larger RV endocardial unipolar low-voltage zone (P <.001), larger RV endocardial/epicardial bipolar low-voltage zone/scar (P <.05), and longer RV endocardial/epicardial total activation time (P <.001 and P =.004, respectively). Conclusion: The number of abnormal SAECG criteria was correlated with the extent of diseased epicardial substrates and could be a potential surrogate marker for predicting the requirement of epicardial ablation in patients with ARVC.

Original languageEnglish
Pages (from-to)584-591
Number of pages8
JournalHeart Rhythm
Volume17
Issue number4
DOIs
Publication statusPublished - Apr 2020
Externally publishedYes

Keywords

  • Arrhythmogenic right ventricular cardiomyopathy
  • Epicardial approach
  • Epicardial substrate
  • Signal-averaged ECG
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Chung, F. P., Lin, C. Y., Lin, Y. J., Chang, S. L., Lo, L. W., Hu, Y. F., Tuan, T. C., Chao, T. F., Liao, J. N., Chang, T. Y., Tan, V. H., Kuo, L., Wu, C. I., Liu, C. M., Vicera, J. J. B., Chen, C. C., Chin, C. G., Liu, S. H., Cheng, W. H., ... Chen, S. A. (2020). Application of noninvasive signal-averaged electrocardiogram analysis in predicting the requirement of epicardial ablation in patients with arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm, 17(4), 584-591. https://doi.org/10.1016/j.hrthm.2019.11.018