Correlation between signal-averaged ecg and the histologic evaluation of the myocardial substrate in right ventricular outflow tract arrhythmias

Pasquale Santangeli, Maurizio Pieroni, Antonio Dello Russo, Michela Casella, Gemma Pelargonio, Luigi Di Biase, Andrea Macchione, J. David Burkhardt, Fulvio Bellocci, Pietro Santarelli, Claudio Tondo, Andrea Natale

Research output: Contribution to journalArticle


Background-The differential diagnosis between idiopathic and cardiomyopathy-related right ventricular outflow tract (RVOT) ventricular arrhythmias (VAs) is crucial. Signal-averaged ECG (SAECG) abnormalities are frequent in cardiomyopathy-related RVOT-VAs, although their pathophysiologic basis and diagnostic value in this setting are undefined. We tested the association between SAECG and the myocardial substrate underlying RVOT-VAs. Methods and Results-Twenty-four consecutive patients (median age, 50 years [42-59]; 12 men) with RVOT-VAs (10 with frequent [>1000/24 hours] premature ventricular contractions, 14 with ventricular tachycardias) underwent SAECG with 40-Hz filtering and electroanatomic mapping (EAM) with EAM-guided biopsy for characterization of the RVOT-VAs substrate. A filtered averaged QRS (fQRS) was obtained and analyzed for fQRS duration, low amplitude signal duration 2) of the RVOT scar and all 3 SAECG parameters (r s=0.76, P2. Conclusions-In patients with RVOT-VAs, abnormal SAECG parameters reflect the presence of extensive cardiomyopathic involvement of the RVOT. However, a negative SAECG does not reliably rule out cardiomyopathy-related RVOT-VAs in the presence of a small RVOT scar. (Circ Arrhythm Electrophysiol. 2012;5:475-483.)

Original languageEnglish
Pages (from-to)475-483
Number of pages9
JournalCirculation: Arrhythmia and Electrophysiology
Issue number3
Publication statusPublished - Jun 2012



  • Right ventricular outflow tract tachycardia
  • Signal-averaged ECG
  • Three-dimensional electroanatomic mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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