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Hoogendoorn JC, Venlet J, Out YNJ, et al. The precordial R' wave: A novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia. Heart Rhythm. 2021;18(9):1539-1547doi: 10.1016/j.hrthm.2021.04.032.
Hoogendoorn, J. C., Venlet, J., Out, Y. N. J., Man, S., Kumar, S., Sramko, M., Dechering, D. G., Nakajima, I., Siontis, K. C., Watanabe, M., Nakamura, Y., Tedrow, U. B., Bogun, F., Eckardt, L., Peichl, P., Stevenson, W. G., & Zeppenfeld, K. (2021). The precordial R' wave: A novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia. Heart rhythm, 18(9), 1539-1547. https://doi.org/10.1016/j.hrthm.2021.04.032
Hoogendoorn, Jarieke C, et al. "The precordial R' wave: A novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia." Heart rhythm vol. 18,9 (2021): 1539-1547. doi: https://doi.org/10.1016/j.hrthm.2021.04.032
Hoogendoorn JC, Venlet J, Out YNJ, Man S, Kumar S, Sramko M, Dechering DG, Nakajima I, Siontis KC, Watanabe M, Nakamura Y, Tedrow UB, Bogun F, Eckardt L, Peichl P, Stevenson WG, Zeppenfeld K. The precordial R' wave: A novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia. Heart Rhythm. 2021 Sep;18(9):1539-1547. doi: 10.1016/j.hrthm.2021.04.032. Epub 2021 May 03. PMID: 33957319.
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Heart Rhythm. 2021 Sep;18(9):1539-1547. doi: 10.1016/j.hrthm.2021.04.032. Epub 2021 May 03.

The precordial R' wave: A novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia.

Heart rhythm

Jarieke C Hoogendoorn, Jeroen Venlet, Yannick N J Out, Sumche Man, Saurabh Kumar, Marek Sramko, Dirk G Dechering, Ikutaro Nakajima, Konstantinos C Siontis, Masaya Watanabe, Yoshinori Nakamura, Usha B Tedrow, Frank Bogun, Lars Eckardt, Petr Peichl, William G Stevenson, Katja Zeppenfeld

Affiliations

  1. Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands.
  2. Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
  3. Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, The Czech Republic.
  4. Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany.
  5. Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
  6. Department of Cardiology, University of Michigan, Ann Arbor, Michigan; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  7. Department of Cardiology, Hokkaido University Hospital, Hokkaido, Japan.
  8. Department of Cardiology, University of Michigan, Ann Arbor, Michigan.
  9. Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: [email protected].

PMID: 33957319 DOI: 10.1016/j.hrthm.2021.04.032

Abstract

BACKGROUND: Cardiac sarcoidosis (CS) with right ventricular (RV) involvement can mimic arrhythmogenic right ventricular cardiomyopathy (ARVC). Histopathological differences may result in disease-specific RV activation patterns detectable on the 12-lead electrocardiogram. Dominant subepicardial scar in ARVC leads to delayed activation of areas with reduced voltages, translating into terminal activation delay and occasionally (epsilon) waves with a small amplitude. Conversely, patchy transmural RV scar in CS may lead to conduction block and therefore late activated areas with preserved voltages reflected as preserved R' waves.

OBJECTIVE: The purpose of this study was to evaluate the distinct terminal activation patterns in precordial leads V

METHODS: Thirteen patients with CS affecting the RV and 23 patients with gene-positive ARVC referred for ventricular tachycardia ablation were retrospectively included in a multicenter approach. A non-ventricular-paced 12-lead surface electrocardiogram was analyzed for the presence and the surface area of the R' wave (any positive deflection from baseline after an S wave) in leads V

RESULTS: An R' wave in leads V

CONCLUSION: An easily applicable algorithm including PR prolongation and the surface area of the maximum R' wave in leads V

Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Keywords: Arrhythmogenic right ventricular cardiomyopathy; Cardiac sarcoidosis; Right bundle branch block; Twelve-lead surface electrocardiogram; Ventricular tachycardia

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