ARVD before antiarrhythmic Surgery

 

This picture has been taken at the time of surgery

It shows the RV with major dilatation covered by an extensive amount of fatty tissue.

 The left ventricle (dark epicardium) is of normal size.

The intriguing aspect of this picture is to show the presence of multiple coronary arteries which have never been described by pathologists as far as I know. 

What is your interpretation ?

Vectorial interpretation of VT/SVT signals stored in the ICD

An ARVD patient experienced episodes of tachycardia 
The problem was the interpretation of EGMS stored in the 
ICD memory. What was the kind of Tachycardia VT or SVT ?

Analysis finally concluded that the patient had both forms of tachycardia : Ventricular Tachycardia (VT) as well as Supra Ventricular Tachycardia (SVT).

Important analysis of full thickness RV myocardium

This document was obtained from the man who died suddenly with Holter recording

This figure shows a unique and important information about the disease biomechanics. It is now for me obvious to see that we have two layers of myocardium Endocardial longitudinal and Epicardial layers which are perpendicular to the endocardial layers.  

27 weeks old Fetus Histology

The native form of ARVD

There is more preserved tissue on the endocardial layers. However, there is also more fibrosis than in the mediomural layers. Also note more fibrosis around distal coronary vessels

This specimen shows the presence of thin layers 

of interstitial fibrosis.Also note that Fibrosis is more severe around distal coronary vessel.

On this specimen there is no major increase in the wall of the vessel displayed on the lower right of the figure.

Sample of RV in unique ARVD patient

This patient died at night of "Torsade de Pointe" like polymorphous Ventricular TAchycardia wearing a Holter recording for pulse abnormality waiting for an EP study planed on the next morning (the top image has been modified by addition of the ECG on the right).

This is an interesting example of fibrofatty replacement of myocardium of the patient who died at night of Torsade de Pointe like with typical ARVD presented on top of this slide.

ARVCs

This modified figure of native ARVD has been published in the EHJ Volume 32 Issue 9 of May 2011

The multiple facets of ARVCs

Already available on the EHJ Website This article will be published in the middle of May in the EHJ