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Correlations between surface ECGs, epicardial mapping and histological data in 15 cases of arrhythmogenic right ventricular dysplasia (ARVD) provide information about the possible mechanism of intraventricular conduction defects in about one third of cases. Two cases in this series had complete right bundle branch block and 4 cases showed diffuse intraventricular conduction defects. The other cases had normal ECGs. The point of origin of the activation in 11 cases was situated in the left ventricle, even in 6 of the 9 cases with normal ECGs. The points of latest activation were located over the right ventricular free wall near the atrio-ventricular groove. However, in all cases but one, a normal right ventricular point of origin was observed, suggesting participation of the right bundle within a free wall showing delayed activation. This activation showed very irregular delayed propagation due to the zones of dysplasia. These results suggest that in ARVD, the mechanism of the conduction defects is not disease of the bundle branch itself but a distal block probably situated in the right ventricular wall. This hypothesis is supported by the histological appearances of the dysplastic zones.
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