Circulation, Vol 68, 1171-1181, Copyright © 1983 by American Heart Association
JE Strain, RM Grose, SM Factor and JD Fisher
To evaluate possible occult myocardial disease in 18 patients whose only
major manifestation of heart disease was spontaneous ventricular
tachycardia or fibrillation, right ventricular endomyocardial biopsies were
performed. None of the patients had symptoms of ischemic or congestive
heart disease, and at catheterization none had significant lesions of the
coronary arteries or regional wall motion abnormalities of the left
ventricle. The mean left ventricular ejection fraction (65 +/- 7%), mean
right ventricular ejection fraction (55 +/- 9%), mean cardiac index (3.0
+/- 0.5 1/min/m2), mean right atrial pressure, mean pulmonary capillary
wedge pressure, and mean pulmonary artery systolic pressure were normal.
However, right ventricular endomyocardial biopsy specimens were abnormal in
16 of 18 (89%) patients: nine (50%) had changes of a significant, although
nonspecific, cardiomyopathy with myocellular hypertrophy, interstitial and
perivascular fibrosis, and vascular sclerosis; three (17%) had subacute
inflammatory myocarditis; two (11%) had diffuse abnormalities of the
intramyocardial arteries; and two (11%) had pathologic changes consistent
with arrhythmogenic right ventricular dysplasia. In the two (11%) patients
with normal biopsy specimens, one had Wolff-Parkinson-White syndrome and
the other had mitral valve prolapse. Although histologic abnormalities were
found in 89% of these patients, performance of right ventricular
endomyocardial biopsies in this group of patients should be considered a
research procedure. We conclude that the majority of patients who have
serious ventricular arrhythmias but no apparent structural cardiac
abnormalities have abnormal right ventricular biopsy specimens and that the
arrhythmias may be the first manifestation of a variety of primary
myocardial abnormalities.
ARTICLES
Results of endomyocardial biopsy in patients with spontaneous ventricular tachycardia but without apparent structural heart disease
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