Echocardiographic and histologic evaluation of the right ventricle in ventricular tachycardias of left bundle branch block morphology without overt cardiac abnormality

Davendra Mehta, Hiroaki Odawara, David E. Ward, William J. McKenna, Michael J. Davies, A. John Camm

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

The right ventricle was investigated by multiple biopsies and detailed echocardiographic evaluation, including measurement of cavity dimensions at the level of the inflow, body and outflow tract, in 27 patients with right ventricular tachycardia who had no clinical evidence of an underlying morphologic abnormality. Nine (33%) patients had abnormal biopsy results, with a quantifiable increase in interstitial fibrosis. Abnormal echocardiograms, defined as an increase in ≥2 dimensions of the right ventricular cavity or wall motion abnormalities or both, were seen in 9 patients. There was a strong association between abnormal myocardial histologies and abnormal right ventricular echocardiograms (p < 0.001). An abnormal echocardiogram was 94% specific and 80% sensitive for an abnormal biopsy. The findings of echocardiography and biopsy were correlated with the electrocardiographic features of the tachycardia. Evidence of right ventricular disease was seen in all 6 patients with superior frontal plane axis of clinical tachycardia as compared with 4 of 21 with inferior axis (p < 0.001). Thus, 2-dimensional echocardiography is a sensitive means of diagnosing right ventricular disease in patients with nonischemic tachycardias of left bundle branch block morphology. A superior frontal plane axis of ventricular tachycardia in this group strongly suggests right ventricular disease, whereas an inferior frontal plane axis is frequently not associated with any morphologic or histologic abnormality of the right ventricle.

Original languageEnglish
Pages (from-to)939-944
Number of pages6
JournalAmerican Journal of Cardiology
Volume63
Issue number13
DOIs
StatePublished - 15 Apr 1989
Externally publishedYes

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