Avella Andrea, d'Amati Giulia, Pappalardo Augusto, Re Federica, Silenzi Paola Francesca, Laurenzi Francesco, DE Girolamo Piergiuseppe, Pelargonio Gemma, Dello Russo Antonio, Baratta Pasquale, Messina Giuseppe, Zecchi Paolo, Zachara Elisabetta, Tondo Claudio
Cardiology Division, Cardiac Arrhythmia and Heart Failure Research Institute, St Camillo-Forlanini Hospital/Catholic University of Sacred Heart, Rome, Italy.
J Cardiovasc Electrophysiol. 2008 Nov;19(11):1127-34. doi: 10.1111/j.1540-8167.2008.01228.x. Epub 2008 Jun 12.
Voltage Mapping-Guided Biopsy in ARVC/D.
To improve the endomyocardial biopsy (EMB) diagnostic sensitivity for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), we hypothesized a biopsy sampling focused on selected right ventricle (RV) low-voltage areas identified by electroanatomic voltage mapping.
The study population (22 patients, 10 men; mean age 34 +/- 10 years) included 11 patients with overt ARVC/D (group A) and 11 patients with suspected ARVC/D (group B), according to both arrhythmic profile and standardized noninvasive diagnostic criteria. In all 22 patients, an RV bipolar voltage mapping was performed with CARTO system sampling multiple endocardial sites (262 +/- 61), during sinus rhythm, with a 0.5-1.5 mV color range setting of voltage display. All 11 (100%) group A patients and 8 of the 11 (73%) group B patients (P = nonsignificant [NS]) presented RV low-voltage areas (<0.5 mV). In 8 group A patients and in all 8 group B patients with a pathological RV voltage map, an EMB focused on the low-voltage areas was performed. In 6 (75%) group A patients and in 7 (87%) group B patients (P = NS), voltage mapping-guided EMB was diagnostic for ARVC/D. In the remaining 3 patients, only nonspecific histological findings were observed.
The results of our study (1) confirm the high diagnostic sensitivity of RV voltage mapping in patients with overt ARVC/D, (2) document a high prevalence of RV low-voltage areas even in patients with suspected ARVC/D, and (3) demonstrate that in patients with clinical evidence or suspicion for ARVC/D, presenting RV low-voltage areas, EMB guided by voltage mapping may provide ARVC/D diagnosis confirmation.
致心律失常性右室心肌病/发育异常中的电压标测引导下活检
为提高心内膜活检（EMB）对致心律失常性右室心肌病/发育异常（ARVC/D）的诊断敏感性，我们假设通过电解剖电压标测确定右心室（RV）特定低电压区域进行活检采样。
根据心律失常特征和标准化无创诊断标准，研究人群（22例患者，10例男性；平均年龄34±10岁）包括11例显性ARVC/D患者（A组）和11例疑似ARVC/D患者（B组）。在所有22例患者中，于窦性心律时使用CARTO系统对多个心内膜部位（262±61个）进行RV双极电压标测，电压显示的颜色范围设置为0.5 - 1.5 mV。A组所有11例（100%）患者和B组11例中的8例（73%）患者（P = 无显著差异[NS]）存在RV低电压区域（<0.5 mV）。在8例A组患者和所有8例具有病理性RV电压图的B组患者中，针对低电压区域进行了EMB。在6例（75%）A组患者和7例（87%）B组患者中（P = NS），电压标测引导下的EMB对ARVC/D具有诊断意义。在其余3例患者中，仅观察到非特异性组织学结果。
我们的研究结果（1）证实显性ARVC/D患者中RV电压标测具有较高的诊断敏感性，（2）表明即使在疑似ARVC/D患者中RV低电压区域也具有较高的发生率，（3）证明在有临床证据或怀疑ARVC/D且存在RV低电压区域的患者中，电压标测引导下的EMB可能有助于确诊ARVC/D。
