This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Markowitz, S. M. Articles by Lerman, B. B. Search for Related Content PubMed PubMed Citation Articles by Markowitz, S. M. Articles by Lerman, B. B. Pubmed/NCBI databases Compound via MeSH Substance via MeSH

(Circulation. 1997;96:1192-1200.)
© 1997 American Heart Association, Inc.

Articles

Adenosine-Sensitive Ventricular Tachycardia

Right Ventricular Abnormalities Delineated by Magnetic Resonance Imaging

Steven M. Markowitz, MD; Bonnie L. Litvak, MD; Elizabeth A. Ramirez de Arellano, MD; John A. Markisz, MD, PhD; Kenneth M. Stein, MD; ; Bruce B. Lerman, MD

From the Department of Medicine, Division of Cardiology, and the Department of Radiology, The New York Hospital–Cornell University Medical Center, New York, NY.

Correspondence to Bruce B. Lerman, MD, Division of Cardiology, Starr 4, The New York Hospital–Cornell Medical Center, 525 E 68th St, New York, NY 10021. E-mail blerman{at}mail.med.cornell.edu

Background Adenosine-sensitive ventricular tachycardia (VT) is thought to be due to cAMP-mediated triggered activity. It typically originates from the RVOT and occurs in patients with apparently normal hearts. Using magnetic resonance imaging (MRI), we tested the hypothesis that adenosine-sensitive VT occurs in patients without structural heart disease.

Methods and Results Fourteen patients (9 women; age, 47±19 years) presented with sustained VT (n=3), repetitive monomorphic VT (n=7), or both (n=4). VT terminated with adenosine in each patient and was sensitive to vagal maneuvers in 9 of 11 and verapamil in 10 of 12. VT originated from the right ventricular outflow tract in 10 patients, the right ventricular apex in 1, and the left ventricular septum in 3. Conventional studies included normal signal-averaged ECGs in 9 of 9, normal right ventricular echocardiography in 10 of 10, and normal left ventriculography and coronary angiography in 6 of 7. In contrast, MRI scans were abnormal in 10 of 14 patients. These abnormalities included focal thinning (6), fatty infiltration (4), and wall motion abnormalities (4) of the right ventricle. The most common site of MRI abnormalities was the right ventricular free wall, but there was a poor correlation between the site of MRI abnormalities and the origin of VT. Among 18 control patients without clinical heart disease, thinning of the right ventricular wall was noted in only 1 patient (patients versus control subjects, P=.0001).

Conclusions Patients with idiopathic adenosine-sensitive VT comprise a heterogeneous group as assessed by MRI, with 70% demonstrating mild structural abnormalities. However, it is unlikely that these findings are causally related to tachycardia, and the functional significance of these anatomic abnormalities is uncertain.

Key Words: imaging • tachycardia • ventricles

This article has been cited by other articles:

				D. Corrado, C. Basso, L. Leoni, B. Tokajuk, P. Turrini, B. Bauce, F. Migliore, A. Pavei, G. Tarantini, M. Napodano, et al. Three-Dimensional Electroanatomical Voltage Mapping and Histologic Evaluation of Myocardial Substrate in Right Ventricular Outflow Tract Tachycardia. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 731 - 739. [Abstract] [Full Text] [PDF]

				C. Timmermans, L.-M. Rodriguez, H. J.G.M. Crijns, A. F.M. Moorman, and H. J.J. Wellens Idiopathic Left Bundle-Branch Block-Shaped Ventricular Tachycardia May Originate Above the Pulmonary Valve Circulation, October 21, 2003; 108(16): 1960 - 1967. [Abstract] [Full Text] [PDF]

				D. O'Donnell, D. Cox, J. Bourke, L. Mitchell, and S. Furniss Clinical and electrophysiological differences between patients with arrhythmogenic right ventricular dysplasia and right ventricular outflow tract tachycardia Eur. Heart J., May 1, 2003; 24(9): 801 - 810. [Abstract] [Full Text] [PDF]

				H. W. M. Kayser, E. E. van der Wall, M. U. Sivananthan, S. Plein, T. N. Bloomer, and A. de Roos Diagnosis of Arrhythmogenic Right Ventricular Dysplasia: A Review RadioGraphics, May 1, 2002; 22(3): 639 - 648. [Abstract] [Full Text] [PDF]

				F Niroomand, C Carbucicchio, C Tondo, S Riva, G Fassini, A Apostolo, N Trevisi, and P Della Bella Electrophysiological characteristics and outcome in patients with idiopathic right ventricular arrhythmia compared with arrhythmogenic right ventricular dysplasia Heart, January 1, 2002; 87(1): 41 - 47. [Abstract] [Full Text] [PDF]

				F. Ahmad, D. Li, A. Karibe, O. Gonzalez, T. Tapscott, R. Hill, D. Weilbaecher, P. Blackie, M. Furey, M. Gardner, et al. Localization of a Gene Responsible for Arrhythmogenic Right Ventricular Dysplasia to Chromosome 3p23 Circulation, December 22, 1998; 98(25): 2791 - 2795. [Abstract] [Full Text] [PDF]

				K. Matsuo, T. Nishikimi, C. Yutani, T. Kurita, W. Shimizu, A. Taguchi, K. Suyama, N. Aihara, S. Kamakura, K. Kangawa, et al. Diagnostic Value of Plasma Levels of Brain Natriuretic Peptide in Arrhythmogenic Right Ventricular Dysplasia Circulation, December 1, 1998; 98(22): 2433 - 2440. [Abstract] [Full Text] [PDF]