Arrhythmic Events in Early ARVC

Study Questions:

Are there markers of arrhythmic events in the early stage of arrhythmogenic right ventricular cardiomyopathy (ARVC)?

Methods:

A signal-averaged electrocardiogram (SAECG) and echocardiogram were performed at the time of initial evaluation of 162 patients (mean age 41 years) with ARVC. Early ARVC was defined as possible or borderline ARVC based on the 2010 ARVC Task Force Criteria. An arrhythmic event (AE) was defined as ventricular tachycardia, cardiac syncope, or aborted sudden death.

Results:

Seventy-three patients had early ARVC and 21% of these patients had experienced an AE. Among the 89 patients with overt ARVC, 78% had experienced an AE. The AEs had occurred a mean of 3.2 months before undergoing echocardiography. In the early ARVC group, the significant discriminators between the patients with and without a prior AE were right ventricular (RV) diameter, RV mechanical dispersion, filtered QRS duration, high-frequency low-amplitude duration, root mean square, and epsilon waves. The best discrimination between patients with and without a prior AE was achieved when combining RV diameter and mechanical dispersion with the SAECG parameters and epsilon waves.

Conclusions:

A combination of echocardiographic and electrical parameters best identifies patients with early ARVC who have had a previous AE.

Perspective:

The patients in this study already had experienced an AE before undergoing evaluation. Therefore, the results do not demonstrate that the echocardiographic and SAECG parameters identified in the study are useful for prospective risk stratification. The main clinical implication of the results is that patients with early ARVC who are found to have the abnormal parameters identified in this study should be monitored closely for ventricular arrhythmias.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound

Keywords: Arrhythmias, Cardiac, Arrhythmogenic Right Ventricular Dysplasia, Cardiac Imaging Techniques, Death, Sudden, Echocardiography, Electrocardiography, Syncope, Tachycardia, Ventricular


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