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Ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy: clinical presentation, risk stratification and results of long-term follow-up.
Int J Cardiol. 2006 Mar 08; 107(3):360-8.IJ

Abstract

BACKGROUND

Not all patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are at risk for sudden cardiac death. The aim of the study was to evaluate the risk stratification in patients with ARVD/C.

METHODS AND RESULTS

Programmed ventricular stimulation (PVS) was performed in 34 ARVD/C patients. Twenty-two, 7 and 4 patients had documented sustained monomorphic ventricular tachycardia (smVT), non-smVT and ventricular fibrillation, respectively. One patient experienced syncope only. An implantable cardioverter defibrillator (ICD) was implanted in 11 patients inducible in smVT with hemodynamic compromise, in 4 patients with documented ventricular fibrillation and in one patient with non-smVT (194 ms tachycardia cycle length) (ICD group, n = 16). Ten patients were left without any antiarrhythmic therapy, 5 patients received antiarrhythmic drugs and 3 patients underwent successful VT ablation (non-ICD group, n = 18). Thirteen patients had an abnormal signal averaged ECG. During 6.5 +/- 2.4 years 69% of ICD patients received appropriate discharges and one non-ICD patient had a hemodynamically tolerated smVT recurrence (no sudden cardiac death in both groups). Comparison between the cycle lengths of clinical VT, induced VT and follow-up VT revealed a strong relationship (R = 0.62-0.88). On multivariate analysis abnormal signal averaged ECG and decreased left ventricular ejection fraction were statistically significant predictors for VT recurrence.

CONCLUSIONS

In ARVD/C the tachycardia cycle length of clinical VT, PVS-induced VT and follow-up VT correlate well implicating that a PVS-guided approach does not provide additional information. Spontaneous arrhythmia in combination with clinical presentation allows identification of patients in need for an ICD.

Authors+Show Affiliations

Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. thomas.pezawas@meduniwien.ac.atNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

16503259

Citation

Pezawas, Thomas, et al. "Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia/cardiomyopathy: Clinical Presentation, Risk Stratification and Results of Long-term Follow-up." International Journal of Cardiology, vol. 107, no. 3, 2006, pp. 360-8.
Pezawas T, Stix G, Kastner J, et al. Ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy: clinical presentation, risk stratification and results of long-term follow-up. Int J Cardiol. 2006;107(3):360-8.
Pezawas, T., Stix, G., Kastner, J., Schneider, B., Wolzt, M., & Schmidinger, H. (2006). Ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy: clinical presentation, risk stratification and results of long-term follow-up. International Journal of Cardiology, 107(3), 360-8.
Pezawas T, et al. Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia/cardiomyopathy: Clinical Presentation, Risk Stratification and Results of Long-term Follow-up. Int J Cardiol. 2006 Mar 8;107(3):360-8. PubMed PMID: 16503259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ventricular tachycardia in arrhythmogenic right ventricular dysplasia/cardiomyopathy: clinical presentation, risk stratification and results of long-term follow-up. AU - Pezawas,Thomas, AU - Stix,Guenter, AU - Kastner,Johannes, AU - Schneider,Barbara, AU - Wolzt,Michael, AU - Schmidinger,Herwig, PY - 2004/12/12/received PY - 2005/03/25/revised PY - 2005/03/26/accepted PY - 2006/3/1/pubmed PY - 2006/7/21/medline PY - 2006/3/1/entrez SP - 360 EP - 8 JF - International journal of cardiology JO - Int J Cardiol VL - 107 IS - 3 N2 - BACKGROUND: Not all patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are at risk for sudden cardiac death. The aim of the study was to evaluate the risk stratification in patients with ARVD/C. METHODS AND RESULTS: Programmed ventricular stimulation (PVS) was performed in 34 ARVD/C patients. Twenty-two, 7 and 4 patients had documented sustained monomorphic ventricular tachycardia (smVT), non-smVT and ventricular fibrillation, respectively. One patient experienced syncope only. An implantable cardioverter defibrillator (ICD) was implanted in 11 patients inducible in smVT with hemodynamic compromise, in 4 patients with documented ventricular fibrillation and in one patient with non-smVT (194 ms tachycardia cycle length) (ICD group, n = 16). Ten patients were left without any antiarrhythmic therapy, 5 patients received antiarrhythmic drugs and 3 patients underwent successful VT ablation (non-ICD group, n = 18). Thirteen patients had an abnormal signal averaged ECG. During 6.5 +/- 2.4 years 69% of ICD patients received appropriate discharges and one non-ICD patient had a hemodynamically tolerated smVT recurrence (no sudden cardiac death in both groups). Comparison between the cycle lengths of clinical VT, induced VT and follow-up VT revealed a strong relationship (R = 0.62-0.88). On multivariate analysis abnormal signal averaged ECG and decreased left ventricular ejection fraction were statistically significant predictors for VT recurrence. CONCLUSIONS: In ARVD/C the tachycardia cycle length of clinical VT, PVS-induced VT and follow-up VT correlate well implicating that a PVS-guided approach does not provide additional information. Spontaneous arrhythmia in combination with clinical presentation allows identification of patients in need for an ICD. SN - 0167-5273 UR - https://www.unboundmedicine.com/medline/citation/16503259/Ventricular_tachycardia_in_arrhythmogenic_right_ventricular_dysplasia/cardiomyopathy:_clinical_presentation_risk_stratification_and_results_of_long_term_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(05)00596-6 DB - PRIME DP - Unbound Medicine ER -