The 2 predominant etiologies of right ventricular tachycardia (VT) are arrhythmogenic right ventricular cardiomyopathy (ARVC) and idiopathic VT arising from the right ventricular outflow tract (RVOT). Both of these arrhythmias can be adrenergically mediated and may be difficult to distinguish clinically. A minor criterion for the diagnosis of ARVC is T wave inversion (TWI) in the right precordial leads during sinus rhythm. However, there have been reports of precordial TWI identified in patients with RVOT tachycardia. The purpose of this study was to determine whether patterns of precordial TWI could differentiate between the two groups. We evaluated a multicenter registry of 229 patients with VT of right ventricular origin. After appropriate exclusions (n=29), 79 patients (58% M, 40±14y) had ARVC, and 121 patients (41% M, 48±14y) had RVOT tachycardia. During sinus rhythm, 37/79 (47%) patients with ARVC and 5/121 (4%) patients with RVOT tachycardia had T-wave inversion in leads V1-V3. For the diagnosis of ARVC, TWI in leads V1-V3 had a sensitivity of 47% and a specificity of 96%. In conclusion, in patients with VT of RV origin, the presence of TWI in electrocardiogram leads V1-V3 supports the diagnosis of ARVC.
Keywords: ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy, ventricular outflow tract tachycardia, electrocardiography