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(Circulation. 1997;95:2668-2676.)
© 1997 American Heart Association, Inc.

Articles

Body-Surface QRST Integral Mapping

Arrhythmogenic Right Ventricular Dysplasia Versus Idiopathic Right Ventricular Tachycardia

Heidi A.P. Peeters, MD; Arne SippensGroenewegen, MD; Bas A. Schoonderwoerd, MSc; Eric F.D. Wever, MD; Cornelis A. Grimbergen, PhD; Richard N.W. Hauer, MD; Etienne O. Robles de Medina, MD

the Department of Cardiology, Heart-Lung Institute, University Hospital Utrecht, Netherlands (H.A.P.P., B.A.S., E.F.D.W., R.N.W.H., E.O.R. de M.); the Section of Cardiac Electrophysiology, Department of Medicine, and the Cardiovascular Research Institute, University of California, San Francisco (A.S.); and the Department of Medical Physics, Academic Medical Center, Amsterdam, Netherlands (C.A.G.).

Correspondence to Heidi A.P. Peeters, MD, Department of Cardiology, Heart-Lung Institute, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. E-mail j.a.vangestel{at}hli.azu.nl

Background Ventricular tachycardia originating in the right ventricle may arise in the presence or absence of structural heart disease. The two main causes of right ventricular tachycardia are arrhythmogenic right ventricular dysplasia (ARVD) and idiopathic right ventricular tachycardia (IRVT) originating from the outflow tract. This study was carried out to determine whether body-surface QRST integral mapping can differentiate patients with ARVD from patients with IRVT.

Methods and Results Body-surface QRST integral maps were obtained during sinus rhythm in 8 patients with ARVD, 8 patients with IRVT, and 27 healthy control subjects. QRST integral maps were analyzed both visually and mathematically. All control subjects had a normal dipolar QRST integral map. In all patients with ARVD, a specific dipolar QRST integral map with an abnormally large negative area covering the entire inferior and right anterior thorax was recorded. In 6 of 8 patients with IRVT, a normal map pattern was found, whereas the remaining 2 patients showed an abnormally large negative area on the right anterior thorax.

Conclusions Patients with ARVD display a specific abnormal QRST integral map that may be related to delayed repolarization in the structurally abnormal right ventricle. The majority of patients with IRVT demonstrate a normal QRST integral map. A slightly abnormal QRST integral map was noted in 2 of 8 patients with IRVT, which may be related to minor structural abnormalities, undetectable by the present routine diagnostic techniques. These preliminary results indicate that body-surface QRST integral mapping may become an important diagnostic tool to differentiate patients with ARVD from those with IRVT.

Key Words: cardiomyopathy • electrocardiography • electrophysiology • mapping • arrhythmia

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