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Signal‐Averaged ECG in the Diagnostic Workup for Arrhythmogenic Cardiomyopathy: Insights From the Nordic ARVC Registry

Authors: Aleksei A. Savelev; Eivind W. Aabel; Anneli Svensson; Pia Dahlberg; Alex Hørby Christensen; Trine Madsen; Henning Bundgaard; +7 Authors

Signal‐Averaged ECG in the Diagnostic Workup for Arrhythmogenic Cardiomyopathy: Insights From the Nordic ARVC Registry

Abstract

Background The diagnostic role of signal‐averaged ECG (SAECG) in arrhythmogenic right ventricular cardiomyopathy (ARVC) has lately been questioned. We assessed the value of SAECG‐derived late ventricular potentials (LP) in ARVC diagnosis and its association with disease manifestations. Methods and Results Patients with definite ARVC diagnosis or genotype‐positive family members who underwent SAECG were included in register‐based observational study (n=357, mean age 41 years, 47% female, 43% probands). LP and terminal activation duration (TAD) were defined by Task Force Criteria 2010. We assessed the association of TAD and LP with structural RV abnormalities and ventricular tachycardia (VT), defined as sustained VT, appropriate implantable cardioverter‐defibrillator shock, aborted cardiac arrest, or sudden cardiac death, at diagnosis. LP were documented in 210 patients (59%) and abnormal TAD in 66 patients (18%). Each of the SAECG parameters was significantly associated with definite ARVC diagnosis in receiver‐operator characteristics curve analysis with area under the curve between 0.67 and 0.74. Exclusion of SAECG from diagnostic workup led to reclassification of 37 patients (16%) from definite to borderline ARVC (13 probands, 9 of whom had prevalent VT). Ninety patients (25%) had history of VT. LP, but not TAD, were associated with VT (adjusted odds ratio [OR adj ], 2.42 [95%CI, 1.07–5.48]). LP had lower specificity (72% versus 97%) but higher sensitivity (71% versus 25%) for association with RV structural abnormalities than TAD. Conclusions In the Nordic ARVC cohort SAECG‐derived LP are associated with VT and structural RV abnormalities and were critical for ascertainment of ARVC diagnosis in 16% of patients with narrow QRS complexes, including 8% of all probands.

Keywords

signal-averaged ECG, Male, Adult, Electrocardiography/methods, Arrhythmogenic cardiomyopathy, Action Potentials, Scandinavian and Nordic Countries, arrhythmogenic cardiomyopathy; arrhythmogenic right ventricular cardiomyopathy; ARVC; signal-averaged ECG; ventricular late potentials, Electrocardiography, Kardiologi och kardiovaskulära sjukdomar, Predictive Value of Tests, Tachycardia, Ventricular/diagnosis, ARVC, Diseases of the circulatory (Cardiovascular) system, Humans, Ventricular late potentials, Registries, Death, Sudden, Cardiac/etiology, Arrhythmogenic Right Ventricular Dysplasia, Original Research, arrhythmogenic right ventricular cardiomyopathy, ventricular late potentials, signal‐averaged ECG, arrhythmogenic cardiomyopathy, Middle Aged, Arrhythmogenic Right Ventricular Dysplasia/diagnosis, General medicine, internal medicine and other clinical medicine, Scandinavian and Nordic Countries/epidemiology, Death, Sudden, Cardiac, ROC Curve, RC666-701, Arvc, Tachycardia, Ventricular, Female, Arrhythmogenic right ventricular cardiomyopathy, Cardiology and Cardiovascular Disease

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selected citations
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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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