Ventricular arrhythmias in the North American multidisciplinary study of ARVC

Predictors, characteristics, and treatment

Mark S. Link, Douglas Laidlaw, Bronislava Polonsky, Wojciech Zareba, Scott McNitt, Kathleen Gear, Frank Marcus, N. A Mark Estes

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with sudden cardiac death. However, the selection of patients for implanted cardioverter-defibrillators (ICDs), as well as programming of the ICD, is unclear. Objectives The objective of this study was to identify predictors, characteristics, and treatment of ventricular arrhythmias in patients with ARVC. Methods The Multidisciplinary Study of Right Ventricular Cardiomyopathy established the North American ARVC Registry and enrolled patients with a diagnosis of ARVC. Patients were followed prospectively. Results Of 137 patients enrolled, 108 received ICDs. Forty-eight patients had 502 sustained episodes of ventricular arrhythmias, including 489 that were monomorphic and 13 that were polymorphic. In the patients with ICDs, independent predictors of ventricular arrhythmias in follow-up included spontaneous sustained ventricular arrhythmias before ICD implantation and T-wave inversions inferiorly. The only independent predictor for life-threatening arrhythmias, defined as sustained ventricular tachycardia (VT) ≥240 beats/min or ventricular fibrillation, was a younger age at enrollment. Anti-tachycardia pacing (ATP), independent of the cycle length of the VT, was successful in terminating 92% of VT episodes. Conclusions In the North American ARVC Registry, the majority of ventricular arrhythmias in follow-up are monomorphic. Risk factors for ventricular arrhythmias were spontaneous ventricular arrhythmias before enrollment and a younger age at ICD implantation. ATP is highly successful in terminating VT, and all ICDs should be programmed for ATP, even for rapid VT.

Original languageEnglish (US)
Pages (from-to)119-125
Number of pages7
JournalJournal of the American College of Cardiology
Volume64
Issue number2
DOIs
StatePublished - Jul 15 2014

Fingerprint

Arrhythmogenic Right Ventricular Dysplasia
Defibrillators
Cardiac Arrhythmias
Ventricular Tachycardia
Tachycardia
Therapeutics
Registries
Sudden Cardiac Death
Ventricular Fibrillation
Cardiomyopathies
Patient Selection

Keywords

  • arrhythmogenic right ventricular cardiomyopathy
  • implantable cardioverter-defibrillator
  • ventricular arrhythmia
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular arrhythmias in the North American multidisciplinary study of ARVC : Predictors, characteristics, and treatment. / Link, Mark S.; Laidlaw, Douglas; Polonsky, Bronislava; Zareba, Wojciech; McNitt, Scott; Gear, Kathleen; Marcus, Frank; Estes, N. A Mark.

In: Journal of the American College of Cardiology, Vol. 64, No. 2, 15.07.2014, p. 119-125.

Research output: Contribution to journalArticle

Link, Mark S. ; Laidlaw, Douglas ; Polonsky, Bronislava ; Zareba, Wojciech ; McNitt, Scott ; Gear, Kathleen ; Marcus, Frank ; Estes, N. A Mark. / Ventricular arrhythmias in the North American multidisciplinary study of ARVC : Predictors, characteristics, and treatment. In: Journal of the American College of Cardiology. 2014 ; Vol. 64, No. 2. pp. 119-125.
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AU - Marcus, Frank

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N2 - Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with sudden cardiac death. However, the selection of patients for implanted cardioverter-defibrillators (ICDs), as well as programming of the ICD, is unclear. Objectives The objective of this study was to identify predictors, characteristics, and treatment of ventricular arrhythmias in patients with ARVC. Methods The Multidisciplinary Study of Right Ventricular Cardiomyopathy established the North American ARVC Registry and enrolled patients with a diagnosis of ARVC. Patients were followed prospectively. Results Of 137 patients enrolled, 108 received ICDs. Forty-eight patients had 502 sustained episodes of ventricular arrhythmias, including 489 that were monomorphic and 13 that were polymorphic. In the patients with ICDs, independent predictors of ventricular arrhythmias in follow-up included spontaneous sustained ventricular arrhythmias before ICD implantation and T-wave inversions inferiorly. The only independent predictor for life-threatening arrhythmias, defined as sustained ventricular tachycardia (VT) ≥240 beats/min or ventricular fibrillation, was a younger age at enrollment. Anti-tachycardia pacing (ATP), independent of the cycle length of the VT, was successful in terminating 92% of VT episodes. Conclusions In the North American ARVC Registry, the majority of ventricular arrhythmias in follow-up are monomorphic. Risk factors for ventricular arrhythmias were spontaneous ventricular arrhythmias before enrollment and a younger age at ICD implantation. ATP is highly successful in terminating VT, and all ICDs should be programmed for ATP, even for rapid VT.

AB - Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with sudden cardiac death. However, the selection of patients for implanted cardioverter-defibrillators (ICDs), as well as programming of the ICD, is unclear. Objectives The objective of this study was to identify predictors, characteristics, and treatment of ventricular arrhythmias in patients with ARVC. Methods The Multidisciplinary Study of Right Ventricular Cardiomyopathy established the North American ARVC Registry and enrolled patients with a diagnosis of ARVC. Patients were followed prospectively. Results Of 137 patients enrolled, 108 received ICDs. Forty-eight patients had 502 sustained episodes of ventricular arrhythmias, including 489 that were monomorphic and 13 that were polymorphic. In the patients with ICDs, independent predictors of ventricular arrhythmias in follow-up included spontaneous sustained ventricular arrhythmias before ICD implantation and T-wave inversions inferiorly. The only independent predictor for life-threatening arrhythmias, defined as sustained ventricular tachycardia (VT) ≥240 beats/min or ventricular fibrillation, was a younger age at enrollment. Anti-tachycardia pacing (ATP), independent of the cycle length of the VT, was successful in terminating 92% of VT episodes. Conclusions In the North American ARVC Registry, the majority of ventricular arrhythmias in follow-up are monomorphic. Risk factors for ventricular arrhythmias were spontaneous ventricular arrhythmias before enrollment and a younger age at ICD implantation. ATP is highly successful in terminating VT, and all ICDs should be programmed for ATP, even for rapid VT.

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