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Can monomorphic RVOT cause premature atrial contraction?

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Posted on Fri, 13 May 2016
Question: I have had several Echo cardiograms and have also worn a cardiac monitor halter (short term) several times. These have only uncovered a few SVTs or possibly some NSVTs. I have been told my heart is okay; however, I continue to have palpitations. I have no family medical history because I was adopted at 2 months of age. My PCP has ordered another Echo. I suspect I may be experiencing RVOT. I have a sensitivity to Adenosine. I am taking flecainide but have been advised to wean off it.
Please answer these Qs:
1) If I have monomorphic RVOT, how can that cause SVT? Can monomorphic RVOT cause PAC?
2) Does a cardiac MRI seem like a better diagnostic test for me?
Thank you.
doctor
Answered by Dr. Ilir Sharka (2 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

Regarding your concern, I would like to explain that right ventricular outflow tract (RVOT) tachycardia may be seen in around 10% of individuals with structurally normal hearts.

1) But before concluding on a RVOT ventricular tachycardia or whether a supraventricular is present instead, it is important to investigate the ECG patterns in several leads (V1, DII, DIII, aVF, aVL, aVR), for concluding on the arrhythmogenic focus of tachycardia (anterior or posterior RVOT).

Please could you upload an ECG recording with presence of tachycardia.

Depending on the degree of focal fibrosis (conotruncal region) will depend the predisposition for triggering tachycardia which is of ventricular origin but may resemble a supraventricular tachycardia pattern.

When there exist supra-valvular automatic foci as a consequence of muscular sleeves that cross the pulmonary valve and the right and left coronary cusps of the aortic valve, PACs may be present as well as SVT.

2) Because in the generation of RVOT tachycardia are accused several arrhythmogenic focuses within the conotruncal region (fibrosis, fibrofatty tissue), special imagine studies like MRI may be helpful in revealing these foci, their expansion degree, making thus possible an appropriate ablation attempt.

So, MRI may yield a better view of the problem, making possible an effective treatment with non-pharmacologic approach (cardiac ablation).

Hope to have been helpful!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

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Practicing since :2001

Answered : 4275 Questions

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Can monomorphic RVOT cause premature atrial contraction?

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome on HCM! Regarding your concern, I would like to explain that right ventricular outflow tract (RVOT) tachycardia may be seen in around 10% of individuals with structurally normal hearts. 1) But before concluding on a RVOT ventricular tachycardia or whether a supraventricular is present instead, it is important to investigate the ECG patterns in several leads (V1, DII, DIII, aVF, aVL, aVR), for concluding on the arrhythmogenic focus of tachycardia (anterior or posterior RVOT). Please could you upload an ECG recording with presence of tachycardia. Depending on the degree of focal fibrosis (conotruncal region) will depend the predisposition for triggering tachycardia which is of ventricular origin but may resemble a supraventricular tachycardia pattern. When there exist supra-valvular automatic foci as a consequence of muscular sleeves that cross the pulmonary valve and the right and left coronary cusps of the aortic valve, PACs may be present as well as SVT. 2) Because in the generation of RVOT tachycardia are accused several arrhythmogenic focuses within the conotruncal region (fibrosis, fibrofatty tissue), special imagine studies like MRI may be helpful in revealing these foci, their expansion degree, making thus possible an appropriate ablation attempt. So, MRI may yield a better view of the problem, making possible an effective treatment with non-pharmacologic approach (cardiac ablation). Hope to have been helpful! In case of any further uncertainties, feel free to ask me again. Kind regards, Dr. Iliri