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. 1984 Jan;51(1):15–24. doi: 10.1136/hrt.51.1.15

Ventricular tachycardia of left bundle branch block configuration in patients with isolated right ventricular dilatation. Clinical and electrophysiological features.

E Rowland, W J McKenna, D Sugrue, R Barclay, R A Foale, D M Krikler
PMCID: PMC482302  PMID: 6689916

Abstract

Electrophysiological studies showed ventricular tachycardia in five patients (four male, one female) with isolated right ventricular dilatation. All had been asymptomatic before the onset of palpitation which had developed in adolescence or early adult life. Tachycardia had been associated with syncope in four patients, and three had been resuscitated from ventricular fibrillation before investigation. The electrocardiogram during ventricular tachycardia showed a left bundle branch block pattern, and endocardial mapping at electrophysiological study confirmed the right ventricular origin. The presenting tachycardia could be induced in all patients by programmed stimulation, and in three patients ventricular tachycardia of differing configuration could be induced, but the right ventricular origin and left bundle branch block pattern were maintained. In two patients ventricular tachycardia degenerated into ventricular fibrillation. Cineangiography, cross sectional echocardiography, and multigated radionuclide angiography confirmed the dilated abnormal right ventricle while indicating that left ventricular function was normal. On resting electrocardiograms T wave inversion over the right precordial leads was the sole abnormality. There were no signs of right heart failure and exercise tolerance was normal. Four patients have received maintenance treatment with antiarrhythmic drugs, and one had undergone operative mapping and ablative surgery. Thus ventricular tachycardia complicating right ventricular dilatation may be associated with serious symptoms and ventricular electrical instability; and in adults it may be suspected on clinical grounds by inverted T waves in the right precordial leads.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BISTENI A., SODI-PALLARES D., MEDRANO G. A., PILEGGI F. A new approach for the recognition of ventricular premature beats. Am J Cardiol. 1960 Mar;5:358–369. doi: 10.1016/0002-9149(60)90083-7. [DOI] [PubMed] [Google Scholar]
  2. Bodenheimer M. M., Banka V. S., Helfant R. H. Relation between the site of origin of ventricular premature complexes and the presence and severity of coronary artery disease. Am J Cardiol. 1977 Dec;40(6):865–869. doi: 10.1016/0002-9149(77)90036-4. [DOI] [PubMed] [Google Scholar]
  3. Chapman J. H., Schrank J. P., Crampton R. S. Idiopathic ventricular tachycardia. An intracardiac electrical, hemodynamic and angiographic assessment of six patients. Am J Med. 1975 Oct;59(4):470–480. doi: 10.1016/0002-9343(75)90254-5. [DOI] [PubMed] [Google Scholar]
  4. Cherrier F., Floquet J., Cuillière M., Neimann J. L. Les dysplasies ventriculaires droites: a propos de 7 observations. Arch Mal Coeur Vaiss. 1979 Jul;72(7):766–773. [PubMed] [Google Scholar]
  5. FROMENT R., GALLAVARDIN L., CAHEN P. Paroxysmal ventricular tachycardia; a clinical classification. Br Heart J. 1953 Apr;15(2):172–178. doi: 10.1136/hrt.15.2.172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fitchett D. H., Sugrue D. D., MacArthur C. G., Oakley C. M. Right ventricular dilated cardiomyopathy. Br Heart J. 1984 Jan;51(1):25–29. doi: 10.1136/hrt.51.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fontaine G., Guiraudon G., Frank R., Tereau Y., Fillette F., Marcus F. I., Chomette G., Grosgogeat Y. Dysplasie ventriculaire droite arythmogène et maladie de Uhl. Arch Mal Coeur Vaiss. 1982 Apr;75(4):361–371. [PubMed] [Google Scholar]
  8. Fontaine G., Guiraudon G., Frank R., Vedel J., Grosgogeat Y., Cabrol C. Modern concepts of ventricular tachycardia. The value of electrocardiological investigations and delayed potentials in ventricular tachycardia of ischemic and nonischemic etiology (31 operated cases). Eur J Cardiol. 1978 Nov;8(4-5):565–580. [PubMed] [Google Scholar]
  9. Frank R., Fontaine G., Vedel J., Mialet G., Sol C., Guiraudon G., Grosgogeat Y. Electrocardiologie de quatre cas de dysplasie ventriculaire droite arythmogène. Arch Mal Coeur Vaiss. 1978 Sep;71(9):963–972. [PubMed] [Google Scholar]
  10. Gentzler R. D., 2nd, Briselli M. F., Gault J. H. Angiographic estimation of right ventricular volume in man. Circulation. 1974 Aug;50(2):324–330. doi: 10.1161/01.cir.50.2.324. [DOI] [PubMed] [Google Scholar]
  11. Halphen C., Beaufils P., Azancot I., Baudouy P., Manne B., Slama R. Tachycardies ventriculaires récidivantes par dysplasie ventriculaire droite. Association à des anomalies du ventricule gauche. Arch Mal Coeur Vaiss. 1981 Sep;74(9):1113–1118. [PubMed] [Google Scholar]
  12. Josephson M. E., Horowitz L. N., Farshidi A., Spear J. F., Kastor J. A., Moore E. N. Recurrent sustained ventricular tachycardia. 2. Endocardial mapping. Circulation. 1978 Mar;57(3):440–447. doi: 10.1161/01.cir.57.3.440. [DOI] [PubMed] [Google Scholar]
  13. Josephson M. E., Horowitz L. N., Farshidi A., Spielman S. R., Michelson E. L., Greenspan A. M. Recurrent sustained ventricular tachycardia. 4. Pleomorphism. Circulation. 1979 Mar;59(3):459–468. doi: 10.1161/01.cir.59.3.459. [DOI] [PubMed] [Google Scholar]
  14. Kaplinsky E., Ogawa S., Kmetzo J., Dreifus L. S. Origin of so-called right and left ventricular arrhythmias in acute myocardial ischemia. Am J Cardiol. 1978 Nov;42(5):774–780. doi: 10.1016/0002-9149(78)90097-8. [DOI] [PubMed] [Google Scholar]
  15. Manning G. W., Ahuja S. P., Gutierrez M. R. Electrocardiographic differentiation between ventricular ectopic beats from subjects with normal and diseased hearts. Acta Cardiol. 1968;23(5):462–470. [PubMed] [Google Scholar]
  16. Marcus F. I., Fontaine G. H., Guiraudon G., Frank R., Laurenceau J. L., Malergue C., Grosgogeat Y. Right ventricular dysplasia: a report of 24 adult cases. Circulation. 1982 Feb;65(2):384–398. doi: 10.1161/01.cir.65.2.384. [DOI] [PubMed] [Google Scholar]
  17. Matsumoto M., Matsuo H. Echocardiography for the evaluation of the tricuspid valve, right ventricle, and atrium. Prog Cardiovasc Dis. 1978 Jul-Aug;21(1):1–42. doi: 10.1016/s0033-0620(78)80002-4. [DOI] [PubMed] [Google Scholar]
  18. Pietras R. J., Lam W., Bauernfeind R., Sheikh A., Palileo E., Strasberg B., Swiryn S., Rosen K. M. Chronic recurrent right ventricular tachycardia in patients without ischemic heart disease: clinical, hemodynamic, and angiographic findings. Am Heart J. 1983 Mar;105(3):357–366. doi: 10.1016/0002-8703(83)90350-2. [DOI] [PubMed] [Google Scholar]
  19. Pietras R. J., Mautner R., Denes P., Wu D., Dhingra R., Towne W., Rosen K. M. Chronic recurrent right and left ventricular tachycardia: comparison of clinical, hemodynamic and angiographic findings. Am J Cardiol. 1977 Jul;40(1):32–37. doi: 10.1016/0002-9149(77)90096-0. [DOI] [PubMed] [Google Scholar]
  20. Reiter M. J., Smith W. M., Gallagher J. J. Clinical spectrum of ventricular tachycardia with left bundle branch morphology. Am J Cardiol. 1983 Jan 1;51(1):113–121. doi: 10.1016/s0002-9149(83)80021-6. [DOI] [PubMed] [Google Scholar]
  21. Sugrue D. D., Kamal S., Deanfield J. E., McKenna W. J., Myers M. J., Watson I. A., Oakley C. M., Lavender J. P. Assessment of right ventricular function and anatomy using peripheral vein infusion of krypton 81m. Br J Radiol. 1983 Sep;56(669):657–663. doi: 10.1259/0007-1285-56-669-657. [DOI] [PubMed] [Google Scholar]
  22. Ward D. E., Camm A. J., Spurrell R. A. Ventricular preexcitation due to anomalous nodo-ventricular pathways: report of 3 patients. Eur J Cardiol. 1979 Feb;9(2):111–127. [PubMed] [Google Scholar]

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