Predictors of appropriate implantable defibrillator therapies in patients with arrhythmogenic right ventricular dysplasia

Jonathan P. Piccini, Darshan Dalal, Ariel Roguin, Chandra Bomma, Alan Cheng, Kalpana Prakasa, Jun Dong, Crystal Tichnell, Cynthia James, Stuart Russell, Jane Crosson, Ronald D. Berger, Joseph E. Marine, Gordon F. Tomaselli, Hugh Calkins

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Background: Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden cardiac death. The risk factors for sudden death and indications for implantable cardioverter-defibrillator (ICD) placement in patients with ARVD are not well defined. Objectives: The purpose of this study was to determine which clinical and electrophysiologic variables best predict appropriate ICD therapies in patients with ARVD. Particular attention focused on whether the ICD was implanted for primary or second prevention. Methods: We enrolled 67 patients (mean age 36 ± 14 years) with definite or probable ARVD who had undergone ICD placement. Appropriate ICD therapies were recorded, and Kaplan-Meier analysis was used to compare the event-free survival time between patients based upon the indication for ICD placement (primary vs secondary prevention), results of electrophysiologic testing, and whether the patient had probable or definite ARVD. Results: Over a mean follow-up of 4.4 ± 2.9 years, 40 (73%) of 55 patients who met task force criteria for ARVD and 4 (33%) of 12 patients with probable ARVD had appropriate ICD therapies for ventricular tachycardia/ventricular fibrillation (VT/VF; P = .027). Mean time to ICD therapy was 1.1 ± 1.4 years. Eleven of 28 patients who received an ICD for primary prevention (39%) and 33 of 35 patients who received an ICD for secondary prevention (85%) experienced appropriate ICD therapies (P = .001). Electrophysiologic testing did not predict appropriate ICD interventions in patients who received an ICD for primary prevention. Fourteen patients (21%) received ICD therapy for life-threatening (VT/VF >240 bpm) arrhythmias. There was no difference in the incidence of life-threatening arrhythmias in the primary and secondary prevention groups (P = .29). Conclusion: Patients who meet task force criteria for ARVD are at high risk for sudden cardiac death and should undergo ICD placement for primary and secondary prevention, regardless of electrophysiologic testing results. Further research is needed to confirm that a low-risk subset of patients who may not require ICD placement can be identified.

Original languageEnglish (US)
Pages (from-to)1188-1194
Number of pages7
JournalHeart Rhythm
Volume2
Issue number11
DOIs
StatePublished - Nov 1 2005
Externally publishedYes

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Arrhythmogenic Right Ventricular Dysplasia
Implantable Defibrillators
Primary Prevention
Therapeutics
Secondary Prevention
Cardiac Arrhythmias
Sudden Cardiac Death
Advisory Committees

Keywords

  • Arrhythmia
  • Arrhythmogenic right ventricular dysplasia
  • Cardiomyopathy
  • Implantable cardioverter-defibrillator
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Piccini, J. P., Dalal, D., Roguin, A., Bomma, C., Cheng, A., Prakasa, K., ... Calkins, H. (2005). Predictors of appropriate implantable defibrillator therapies in patients with arrhythmogenic right ventricular dysplasia. Heart Rhythm, 2(11), 1188-1194. https://doi.org/10.1016/j.hrthm.2005.08.022

Predictors of appropriate implantable defibrillator therapies in patients with arrhythmogenic right ventricular dysplasia. / Piccini, Jonathan P.; Dalal, Darshan; Roguin, Ariel; Bomma, Chandra; Cheng, Alan; Prakasa, Kalpana; Dong, Jun; Tichnell, Crystal; James, Cynthia; Russell, Stuart; Crosson, Jane; Berger, Ronald D.; Marine, Joseph E.; Tomaselli, Gordon F.; Calkins, Hugh.

In: Heart Rhythm, Vol. 2, No. 11, 01.11.2005, p. 1188-1194.

Research output: Contribution to journalArticle

Piccini, JP, Dalal, D, Roguin, A, Bomma, C, Cheng, A, Prakasa, K, Dong, J, Tichnell, C, James, C, Russell, S, Crosson, J, Berger, RD, Marine, JE, Tomaselli, GF & Calkins, H 2005, 'Predictors of appropriate implantable defibrillator therapies in patients with arrhythmogenic right ventricular dysplasia', Heart Rhythm, vol. 2, no. 11, pp. 1188-1194. https://doi.org/10.1016/j.hrthm.2005.08.022
Piccini, Jonathan P. ; Dalal, Darshan ; Roguin, Ariel ; Bomma, Chandra ; Cheng, Alan ; Prakasa, Kalpana ; Dong, Jun ; Tichnell, Crystal ; James, Cynthia ; Russell, Stuart ; Crosson, Jane ; Berger, Ronald D. ; Marine, Joseph E. ; Tomaselli, Gordon F. ; Calkins, Hugh. / Predictors of appropriate implantable defibrillator therapies in patients with arrhythmogenic right ventricular dysplasia. In: Heart Rhythm. 2005 ; Vol. 2, No. 11. pp. 1188-1194.
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abstract = "Background: Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden cardiac death. The risk factors for sudden death and indications for implantable cardioverter-defibrillator (ICD) placement in patients with ARVD are not well defined. Objectives: The purpose of this study was to determine which clinical and electrophysiologic variables best predict appropriate ICD therapies in patients with ARVD. Particular attention focused on whether the ICD was implanted for primary or second prevention. Methods: We enrolled 67 patients (mean age 36 ± 14 years) with definite or probable ARVD who had undergone ICD placement. Appropriate ICD therapies were recorded, and Kaplan-Meier analysis was used to compare the event-free survival time between patients based upon the indication for ICD placement (primary vs secondary prevention), results of electrophysiologic testing, and whether the patient had probable or definite ARVD. Results: Over a mean follow-up of 4.4 ± 2.9 years, 40 (73{\%}) of 55 patients who met task force criteria for ARVD and 4 (33{\%}) of 12 patients with probable ARVD had appropriate ICD therapies for ventricular tachycardia/ventricular fibrillation (VT/VF; P = .027). Mean time to ICD therapy was 1.1 ± 1.4 years. Eleven of 28 patients who received an ICD for primary prevention (39{\%}) and 33 of 35 patients who received an ICD for secondary prevention (85{\%}) experienced appropriate ICD therapies (P = .001). Electrophysiologic testing did not predict appropriate ICD interventions in patients who received an ICD for primary prevention. Fourteen patients (21{\%}) received ICD therapy for life-threatening (VT/VF >240 bpm) arrhythmias. There was no difference in the incidence of life-threatening arrhythmias in the primary and secondary prevention groups (P = .29). Conclusion: Patients who meet task force criteria for ARVD are at high risk for sudden cardiac death and should undergo ICD placement for primary and secondary prevention, regardless of electrophysiologic testing results. Further research is needed to confirm that a low-risk subset of patients who may not require ICD placement can be identified.",
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AU - Piccini, Jonathan P.

AU - Dalal, Darshan

AU - Roguin, Ariel

AU - Bomma, Chandra

AU - Cheng, Alan

AU - Prakasa, Kalpana

AU - Dong, Jun

AU - Tichnell, Crystal

AU - James, Cynthia

AU - Russell, Stuart

AU - Crosson, Jane

AU - Berger, Ronald D.

AU - Marine, Joseph E.

AU - Tomaselli, Gordon F.

AU - Calkins, Hugh

PY - 2005/11/1

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N2 - Background: Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden cardiac death. The risk factors for sudden death and indications for implantable cardioverter-defibrillator (ICD) placement in patients with ARVD are not well defined. Objectives: The purpose of this study was to determine which clinical and electrophysiologic variables best predict appropriate ICD therapies in patients with ARVD. Particular attention focused on whether the ICD was implanted for primary or second prevention. Methods: We enrolled 67 patients (mean age 36 ± 14 years) with definite or probable ARVD who had undergone ICD placement. Appropriate ICD therapies were recorded, and Kaplan-Meier analysis was used to compare the event-free survival time between patients based upon the indication for ICD placement (primary vs secondary prevention), results of electrophysiologic testing, and whether the patient had probable or definite ARVD. Results: Over a mean follow-up of 4.4 ± 2.9 years, 40 (73%) of 55 patients who met task force criteria for ARVD and 4 (33%) of 12 patients with probable ARVD had appropriate ICD therapies for ventricular tachycardia/ventricular fibrillation (VT/VF; P = .027). Mean time to ICD therapy was 1.1 ± 1.4 years. Eleven of 28 patients who received an ICD for primary prevention (39%) and 33 of 35 patients who received an ICD for secondary prevention (85%) experienced appropriate ICD therapies (P = .001). Electrophysiologic testing did not predict appropriate ICD interventions in patients who received an ICD for primary prevention. Fourteen patients (21%) received ICD therapy for life-threatening (VT/VF >240 bpm) arrhythmias. There was no difference in the incidence of life-threatening arrhythmias in the primary and secondary prevention groups (P = .29). Conclusion: Patients who meet task force criteria for ARVD are at high risk for sudden cardiac death and should undergo ICD placement for primary and secondary prevention, regardless of electrophysiologic testing results. Further research is needed to confirm that a low-risk subset of patients who may not require ICD placement can be identified.

AB - Background: Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden cardiac death. The risk factors for sudden death and indications for implantable cardioverter-defibrillator (ICD) placement in patients with ARVD are not well defined. Objectives: The purpose of this study was to determine which clinical and electrophysiologic variables best predict appropriate ICD therapies in patients with ARVD. Particular attention focused on whether the ICD was implanted for primary or second prevention. Methods: We enrolled 67 patients (mean age 36 ± 14 years) with definite or probable ARVD who had undergone ICD placement. Appropriate ICD therapies were recorded, and Kaplan-Meier analysis was used to compare the event-free survival time between patients based upon the indication for ICD placement (primary vs secondary prevention), results of electrophysiologic testing, and whether the patient had probable or definite ARVD. Results: Over a mean follow-up of 4.4 ± 2.9 years, 40 (73%) of 55 patients who met task force criteria for ARVD and 4 (33%) of 12 patients with probable ARVD had appropriate ICD therapies for ventricular tachycardia/ventricular fibrillation (VT/VF; P = .027). Mean time to ICD therapy was 1.1 ± 1.4 years. Eleven of 28 patients who received an ICD for primary prevention (39%) and 33 of 35 patients who received an ICD for secondary prevention (85%) experienced appropriate ICD therapies (P = .001). Electrophysiologic testing did not predict appropriate ICD interventions in patients who received an ICD for primary prevention. Fourteen patients (21%) received ICD therapy for life-threatening (VT/VF >240 bpm) arrhythmias. There was no difference in the incidence of life-threatening arrhythmias in the primary and secondary prevention groups (P = .29). Conclusion: Patients who meet task force criteria for ARVD are at high risk for sudden cardiac death and should undergo ICD placement for primary and secondary prevention, regardless of electrophysiologic testing results. Further research is needed to confirm that a low-risk subset of patients who may not require ICD placement can be identified.

KW - Arrhythmia

KW - Arrhythmogenic right ventricular dysplasia

KW - Cardiomyopathy

KW - Implantable cardioverter-defibrillator

KW - Sudden cardiac death

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