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Implantable Cardioverter‐Defibrillator Therapy in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Predictors of Appropriate Therapy, Outcomes, and Complications
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2017
- Publisher :
- John Wiley and Sons Inc., 2017.
-
Abstract
- Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy is characterized by ventricular arrhythmias and sudden cardiac death. Once the diagnosis is established, risk stratification to determine whether implantable cardioverter‐defibrillator ( ICD ) placement is warranted is critical. Methods and Results The cohort included 312 patients (163 men, age at presentation 33.6±13.9 years) with definite arrhythmogenic right ventricular dysplasia/cardiomyopathy who received an ICD . Over 8.8±7.33 years, 186 participants (60%) had appropriate ICD therapy and 58 (19%) had an intervention for ventricular fibrillation/flutter. Ventricular tachycardia at presentation (hazard ratio [ HR ]: 1.86; 95% confidence interval [ CI ], 1.38–2.49; P P P =0.001), inverted T waves in ≥3 precordial leads (HR: 1.66; 95% CI, 1.09–2.52; P =0.018), and premature ventricular contraction count ≥1000/24 hours (HR: 2.30; 95% CI, 1.32–4.00; P =0.003) were predictors of any appropriate ICD therapy. Inducibility at electrophysiology study (HR: 2.28; 95% CI, 1.10–4.70; P =0.025) remained as the only predictor after multivariable analysis. The predictors for ventricular fibrillation/flutter were premature ventricular contraction ≥1000/24 hours (HR: 4.39; 95% CI, 1.32–14.61; P =0.016), syncope (HR: 1.85; 95% CI, 1.10–3.11; P =0.021), aged ≤30 years at presentation (HR: 1.76; 95% CI, 1.04–3.00; P P =0.046). Younger age at presentation (HR: 3.14; 95% CI, 1.32–7.48; P =0.010) and high premature ventricular contraction burden (HR: 4.43; 95% CI, 1.35–14.57; P ICD interventions. Overall mortality was low at 2%, and 4% underwent heart transplantation. Conclusion These findings represent an important step in identifying predictors of ICD therapy for potentially fatal ventricular fibrillation/flutter and should be considered when developing a risk stratification model for arrhythmogenic right ventricular dysplasia/cardiomyopathy.
- Subjects :
- Male
implantable cardioverter defibrillator
Time Factors
medicine.medical_treatment
Cardiomyopathy
arrhythmogenic right ventricular cardiomyopathy/dysplasia
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Arrhythmias
Ventricular tachycardia
Sudden cardiac death
Electrocardiography
0302 clinical medicine
Risk Factors
Arrhythmia and Electrophysiology
030212 general & internal medicine
Arrhythmogenic Right Ventricular Dysplasia
Original Research
medicine.diagnostic_test
Hazard ratio
Middle Aged
Implantable cardioverter-defibrillator
Arrhythmogenic right ventricular dysplasia
Defibrillators, Implantable
Treatment Outcome
Cardiology
Female
Cardiology and Cardiovascular Medicine
Electrophysiologic Techniques, Cardiac
tachyarrhythmias
Adult
medicine.medical_specialty
Clinical Decision-Making
Electric Countershock
Risk Assessment
Ventricular Flutter
sudden cardiac death
03 medical and health sciences
Electrophysiology study
Young Adult
Internal medicine
medicine
Humans
Proportional Hazards Models
Chi-Square Distribution
business.industry
Patient Selection
medicine.disease
ventricular fibrillation
Death, Sudden, Cardiac
Ventricular fibrillation
Multivariate Analysis
business
Catheter Ablation and Implantable Cardioverter-Defibrillator
Subjects
Details
- Language :
- English
- ISSN :
- 20479980
- Volume :
- 6
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Accession number :
- edsair.doi.dedup.....cc4b0f25f96c06a98f2f9073ceb748a5