Myocardial voltage ratio in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Herzschrittmacherther Elektrophysiol. 2017 Jun;28(2):219-224. doi: 10.1007/s00399-017-0508-0. Epub 2017 May 23.


Aims: This study aimed to analyze the influence of scar distribution between the endocardium and the epicardium in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).

Methods: Electroanatomical mapping data were derived from our ARVD/C registry. Myocardial voltage distribution between the endocardium and the epicardium was analyzed in 28 patients (18 men, 49.9 ± 13.0 years) with previous ventricular tachycardia (VT) ablation and complete right ventricular maps.

Results: During the follow-up period of 28 ± 22 months after ablation, 18 of 28 patients (64.3%) remained free from VT recurrence. In univariate analysis, five variables associated with VT recurrence, i. e., advanced age, right ventricular (RV) myocardial voltage ratio ≥0.58, inducibility of VT after ablation, and longer procedure and fluoroscopy time. In binary logistic regression analysis only RV myocardial voltage ratio ≥0.58 (hazard ratio 11.667, 95% confidence interval 1.487-91.543, p = 0.012) remained associated with an increased risk of VT recurrence.

Conclusion: The myocardial voltage ratio (bipolar low voltage area/unipolar low voltage area) as a potential surrogate parameter for scar distribution between the endocardium and the epicardium is significantly associated with the outcome after VT ablation in ARVD/C.

Keywords: Ablation techniques; Endocardium; Epicardium; Unipolar; Ventricular tachycardia.

Publication types

  • Review

MeSH terms

  • Adult
  • Arrhythmogenic Right Ventricular Dysplasia / diagnosis
  • Arrhythmogenic Right Ventricular Dysplasia / physiopathology*
  • Arrhythmogenic Right Ventricular Dysplasia / surgery
  • Catheter Ablation
  • Cicatrix / diagnosis
  • Cicatrix / physiopathology*
  • Cicatrix / surgery
  • Electrocardiography*
  • Endocardium / physiopathology
  • Endocardium / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pericardium / physiopathology
  • Pericardium / surgery
  • Recurrence
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / physiopathology*
  • Tachycardia, Ventricular / surgery