Isolated Subepicardial Right Ventricular Outflow Tract Scar in Athletes With Ventricular Tachycardia.

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.

• Authors: Jeroen Venlet, Sebastiaan R D Piers, Jan D H Jongbloed, Alexander F A Androulakis, Yoshihisa Naruse, Dennis W den Uijl, Gijsbert F L Kapel, Marta de Riva, J Peter van Tintelen, Daniela Q C M Barge-Schaapveld, Martin J Schalij, Katja Zeppenfeld
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 69 Issue 5 Pg. 497-507 (Feb 07 2017) ISSN: 1558-3597 [Electronic] United States
• PMID: 28153106 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Cardiomyopathies (pathology)
• Catheter Ablation
• Electrocardiography
• Female
• Humans
• Male
• Middle Aged
• Physical Endurance (physiology)
• Sports
• Tachycardia, Ventricular (etiology)
• Ventricular Outflow Obstruction (diagnosis, pathology, surgery)
• Ventricular Remodeling (physiology)