Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia

Domenico Corrado, Hugh Calkins, Mark S. Link, Loira Leoni, Stefano Favale, Michela Bevilacqua, Cristina Basso, Deirdre Ward, Giuseppe Boriani, Renato Ricci, Jonathan P. Piccini, Darshan Dalal, Massimo Santini, Gianfranco Buja, Sabino Iliceto, N. A.Mark Estes, Thomas Wichter, William J. McKenna, Gaetano Thiene, Frank I. Marcus

Research output: Contribution to journalArticle

187 Scopus citations

Abstract

Background: The role of implantable cardioverter-defibrillator (ICD) in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation (VF) or sustained ventricular tachycardia is an unsolved issue. Methods and Results: We studied 106 consecutive patients (62 men and 44 women; age, 35.6±18 years) with arrhythmogenic right ventricular cardiomyopathy/dysplasia who received an ICD based on 1 or more arrhythmic risk factors such as syncope, nonsustained ventricular tachycardia, familial sudden death, and inducibility at programmed ventricular stimulation. During follow-up of 58±35 months, 25 patients (24%) had appropriate ICD interventions and 17 (16%) had shocks for life-threatening VF or ventricular flutter. At 48 months, the actual survival rate was 100% compared with the VF/ventricular flutter-free survival rate of 77% (log-rank P=0.01). Syncope significantly predicted any appropriate ICD interventions (hazard ratio, 2.94; 95% confidence interval, 1.83 to 4.67; P=0.013) and shocks for VF/ventricular flutter (hazard ratio, 3.16; 95% confidence interval, 1.39 to 5.63; P=0.005). The positive predictive value of programmed ventricular stimulation was 35% for any appropriate ICD intervention and 20% for shocks for VF/ventricular flutter, with a negative predictive value of 70% and 74%. None of the 27 asymptomatic patients with isolated familial sudden death had appropriate ICD therapy. Twenty patients (19%) had inappropriate ICD interventions, and 18 (17%) had device-related complications. Conclusions: One fourth of patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior sustained ventricular tachycardia or VF had appropriate ICD interventions. Syncope was an important predictor of life-saving ICD intervention and is an indication for ICD. Prophylactic ICD may not be indicated in asymptomatic patients because of their low arrhythmic risk regardless of familial sudden death and programmed ventricular stimulation findings. Programmed ventricular stimulation had a low predictive accuracy for ICD therapy.

Original languageEnglish (US)
Pages (from-to)1144-1152
Number of pages9
JournalCirculation
Volume122
Issue number12
DOIs
StatePublished - Sep 21 2010

Keywords

  • cardiomyopathy
  • death, sudden
  • electrophysiology
  • implantable cardioverter-defibrillators
  • tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Corrado, D., Calkins, H., Link, M. S., Leoni, L., Favale, S., Bevilacqua, M., Basso, C., Ward, D., Boriani, G., Ricci, R., Piccini, J. P., Dalal, D., Santini, M., Buja, G., Iliceto, S., Estes, N. A. M., Wichter, T., McKenna, W. J., Thiene, G., & Marcus, F. I. (2010). Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia. Circulation, 122(12), 1144-1152. https://doi.org/10.1161/CIRCULATIONAHA.109.913871