Exercise-induced ST elevation in patients with arrhythmogenic right ventricular dysplasia

To test the hypothesis that local or diffuse wall motion abnormalities in t he right ventricle in patients with arrhythmogenic right ventricular dyspla sia (ARVD) may induce the ST-segment elevation in response to exercise, we examined exercise electrocardiograms in patients with ARVD. In 17 patients with ARVD, who demonstrated right ventricular wall motion abnormalities wit hout organic coronary lesions, we conducted a treadmill exercise test. Sign ificant exercise-induced ST-segment elevation (ESTE) was defined as a 0.1 m V or more ST-segment elevation at J point. ESTE was observed in 11 patients (65%). It manifested most frequently in right-sided precordial leads. Seve re right ventricular asynergy was seen in all but one (91%) among 11 with E STE, whereas it was seen only in two (33%) among six without ESTE (P < .05) . The maximal magnitude of ESTE inversely correlated with right ventricular ejection fraction (r = -0.58, P < .05). ESTE was seen in two thirds of ARV D patients, helping us noninvasively diagnose ARVD. The fact that ventricul ar wall motion abnormalities could cause ESTE in the absence of organic cor onary lesions suggested the critical role of mechanical factors in the gene sis of ESTE.