Reassessment for the Late Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy in Patients With Ablated Premature Ventricular Contractions or Ventricular Tachycardia in the Right Ventricle

Premature ventricular contractions (PVCs) from a right ventricular outflow origin are the first clinical presentation of an underlying arrhythmogenic right ventricular cardiomyopathy (ARVC). The association between PVCs from the other parts of the right ventricle (RV) and an underlying ARVC is unclear. This study focused on the ARVC risk in patients with PVCs originating from the RV.
 
This cross-sectional study enrolled 69 patients undergoing PVC ablation to remove the arrhythmogenic cores of the RV. Data regarding ventricular arrhythmias, symptoms, and antiarrhythmic drug consumption were gathered. The subjects were recalled for follow-up evaluations using electrocardiography and echocardiography to diagnose cases affected by ARVC. The data were analyzed using SPSS, version 20.
 
Among the participants, 5.8% of the cases were diagnosed with suspected ARVC. The origins of the arrhythmogenic foci were as follows: the right papillary muscles in 11 patients, the moderator bands in 2, the right ventricular outflow tract (RVOT) free wall in 23, the RV low septal wall in 2, and the tricuspid annulus in 31. RVOT dimensions exhibited a meaningful increase over time (P =0.01). The severity of tricuspid regurgitation also increased meaningfully over time (P =0.04).
 
Many patients undergoing ablation therapy on the RV for the treatment of arrhythmogenic foci are at an increased risk of ARVC, and they could exhibit PVCs originating from the other parts of the RV, necessitating robust observation. Increased RVOT dimensions and worsening tricuspid regurgitation should be an alarming sign in these cases. (Iranian Heart Journal 2021; 22(3): 44-52)