Document Detail


Usefulness of inducible ventricular tachycardia to predict long-term adverse outcomes in arrhythmogenic right ventricular cardiomyopathy.
MedLine Citation:
PMID:  23103200     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The role of the electrophysiologic (EP) study for risk stratification in patients with arrhythmogenic right ventricular cardiomyopathy is controversial. We investigated the role of inducible sustained monomorphic ventricular tachycardia (SMVT) for the prediction of an adverse outcome (AO), defined as the occurrence of cardiac death, heart transplantation, sudden cardiac death, ventricular fibrillation, ventricular tachycardia with hemodynamic compromise or syncope. Of 62 patients who fulfilled the 2010 Arrhythmogenic Right Ventricular Cardiomyopathy Task Force criteria and underwent an EP study, 30 (48%) experienced an adverse outcome during a median follow-up of 9.8 years. SMVT was inducible in 34 patients (55%), 22 (65%) of whom had an adverse outcome. In contrast, in 28 patients without inducible SMVT, 8 (29%) had an adverse outcome. Kaplan-Meier analysis showed an event-free survival benefit for patients without inducible SMVT (log-rank p = 0.008) with a cumulative survival free of an adverse outcome of 72% (95% confidence interval [CI] 56% to 92%) in the group without inducible SMVT compared to 26% (95% CI 14% to 50%) in the other group after 10 years. The inducibility of SMVT during the EP study (hazard ratio [HR] 2.99, 95% CI 1.23 to 7.27), nonadherence (HR 2.74, 95% CI 1.3 to 5.77), and heart failure New York Heart Association functional class II and III (HR 2.25, 95% CI 1.04 to 4.87) were associated with an adverse outcome on univariate Cox regression analysis. The inducibility of SMVT (HR 2.52, 95% CI 1.03 to 6.16, p = 0.043) and nonadherence (HR 2.34, 95% CI 1.1 to 4.99, p = 0.028) remained as significant predictors on multivariate analysis. This long-term observational data suggest that SMVT inducibility during EP study might predict an adverse outcome in patients with arrhythmogenic right ventricular cardiomyopathy, advocating a role for EP study in risk stratification.
Authors:
Ardan M Saguner; Argelia Medeiros-Domingo; Moritz A Schwyzer; Chol-Jun On; Laurent M Haegeli; Thomas Wolber; David Hürlimann; Jan Steffel; Nazmi Krasniqi; Sina Rüeger; Leonhard Held; Thomas F Lüscher; Corinna Brunckhorst; Firat Duru
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-10-25
Journal Detail:
Title:  The American journal of cardiology     Volume:  111     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-07     Completed Date:  2013-02-26     Revised Date:  2013-05-14    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Clinic for Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland. ardan.saguner@usz.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Arrhythmogenic Right Ventricular Dysplasia / complications,  diagnosis*,  epidemiology
Death, Sudden, Cardiac / epidemiology
Disease-Free Survival
Electrophysiologic Techniques, Cardiac*
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Predictive Value of Tests
Prognosis
Retrospective Studies
Switzerland / epidemiology
Tachycardia, Ventricular / diagnosis*,  etiology,  physiopathology
Time Factors
Comments/Corrections
Comment In:
Am J Cardiol. 2013 Apr 15;111(8):1236   [PMID:  23558003 ]

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