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Varrenti M, Preda A, Frontera A, Baroni M, Gigli L, Vargiu S, Colombo G, Carbonaro M, Paolucci M, Giordano F, Guarracini F, Mazzone P. Arrhythmogenic Cardiomyopathy: Definition, Classification and Arrhythmic Risk Stratification. J Clin Med 2024; 13:456. [PMID: 38256590 PMCID: PMC10816644 DOI: 10.3390/jcm13020456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a heart disease characterized by a fibrotic replacement of myocardial tissue and a consequent predisposition to ventricular arrhythmic events, especially in the young. Post-mortem studies and the subsequent diffusion of cardiac MRI have shown that left ventricular involvement in arrhythmogenic cardiomyopathy is common and often develops early. Regarding the arrhythmic risk stratification, the current scores underestimate the arrhythmic risk of patients with arrhythmogenic cardiomyopathy with left involvement. Indeed, the data on arrhythmic risk stratification in this group of patients are contradictory and not exhaustive, with the consequence of not correctly identifying patients at a high arrhythmic risk who deserve protection from arrhythmic death. We propose a literature review on arrhythmic risk stratification in patients with ACM and left involvement to identify the main features associated with an increased arrhythmic risk in this group of patients.
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Affiliation(s)
- Marisa Varrenti
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.C.); (F.G.); (P.M.)
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2
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Polovina M, Tschöpe C, Rosano G, Metra M, Crea F, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Corrado D, Bayes-Genis A, Bozkurt B, Filippatos G, Keren A, Skouri H, Moura B, Volterrani M, Abdelhamid M, Ašanin M, Krljanac G, Tomić M, Savarese G, Adamo M, Lopatin Y, Chioncel O, Coats AJS, Seferović PM. Incidence, risk assessment and prevention of sudden cardiac death in cardiomyopathies. Eur J Heart Fail 2023; 25:2144-2163. [PMID: 37905371 DOI: 10.1002/ejhf.3076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
Cardiomyopathies are a significant contributor to cardiovascular morbidity and mortality, mainly due to the development of heart failure and increased risk of sudden cardiac death (SCD). Despite improvement in survival with contemporary treatment, SCD remains an important cause of mortality in cardiomyopathies. It occurs at a rate ranging between 0.15% and 0.7% per year (depending on the cardiomyopathy), which significantly surpasses SCD incidence in the age- and sex-matched general population. The risk of SCD is affected by multiple factors including the aetiology, genetic basis, age, sex, physical exertion, the extent of myocardial disease severity, conduction system abnormalities, and electrical instability, as measured by various metrics. Over the past decades, the knowledge on the mechanisms and risk factors for SCD has substantially improved, allowing for a better-informed risk stratification. However, unresolved issues still challenge the guidance of SCD prevention in patients with cardiomyopathies. In this review, we aim to provide an in-depth discussion of the contemporary concepts pertinent to understanding the burden, risk assessment and prevention of SCD in cardiomyopathies (dilated, non-dilated left ventricular, hypertrophic, arrhythmogenic right ventricular, and restrictive). The review first focuses on SCD incidence in cardiomyopathies and then summarizes established and emerging risk factors for life-threatening arrhythmias/SCD. Finally, it discusses validated approaches to the risk assessment and evidence-based measures for SCD prevention in cardiomyopathies, pointing to the gaps in evidence and areas of uncertainties that merit future clarification.
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Affiliation(s)
- Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute. Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Biykem Bozkurt
- Section of Cardiology, Winters Center for Heart Failure, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Hadassah-Hebrew University Medical Center Jerusalem, Clalit Services District of Jerusalem, Jerusalem, Israel
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Milenko Tomić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- University for Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | | | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
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3
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Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A, Bourfiss M, Fortier A, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, van der Heijden JF, Tandri H, Jongbloed JDH, Guertin MC, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2022; 43:e1-e9. [PMID: 35441664 PMCID: PMC9392651 DOI: 10.1093/eurheartj/ehac180] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 03/01/2019] [Indexed: 12/16/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized by ventricular arrhythmias (VAs) and sudden cardiac death (SCD). We aimed to develop a model for individualized prediction of incident VA/SCD in ARVC patients. METHODS AND RESULTS Five hundred and twenty-eight patients with a definite diagnosis and no history of sustained VAs/SCD at baseline, aged 38.2 ± 15.5 years, 44.7% male, were enrolled from five registries in North America and Europe. Over 4.83 (interquartile range 2.44-9.33) years of follow-up, 146 (27.7%) experienced sustained VA, defined as SCD, aborted SCD, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator (ICD) therapy. A prediction model estimating annual VA risk was developed using Cox regression with internal validation. Eight potential predictors were pre-specified: age, sex, cardiac syncope in the prior 6 months, non-sustained ventricular tachycardia, number of premature ventricular complexes in 24 h, number of leads with T-wave inversion, and right and left ventricular ejection fractions (LVEFs). All except LVEF were retained in the final model. The model accurately distinguished patients with and without events, with an optimism-corrected C-index of 0.77 [95% confidence interval (CI) 0.73-0.81] and minimal over-optimism [calibration slope of 0.93 (95% CI 0.92-0.95)]. By decision curve analysis, the clinical benefit of the model was superior to a current consensus-based ICD placement algorithm with a 20.3% reduction of ICD placements with the same proportion of protected patients (P < 0.001). CONCLUSION Using the largest cohort of patients with ARVC and no prior VA, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs (www.arvcrisk.com).
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Affiliation(s)
- Julia Cadrin-Tourigny
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Laurens P Bosman
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Øyvind H Lie
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Anneli Svensson
- Department of Cardiology, University Hosptial of Linköping, S-581 85 Linköping, Sweden
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands.,Faculty of Population Health Sciences, Institute of Cardiovascular Science, Institute of Health Informatics, University College London, 69-75 Chenies Mews, London, UK
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia 211 - 1033 Davie Street, Vancouver, BC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Stephen Chelko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Jane E Crosson
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, GD, Rotterdam, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - J Peter van Tintelen
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD Amsterdam, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University Hosptial, Lund, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Paul Khairy
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Richard N W Hauer
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Anneline S J M Te Riele
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
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4
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Finocchiaro G, Magavern EF, Georgioupoulos G, Maurizi N, Sinagra G, Carr-White G, Pantazis A, Olivotto I. Sudden cardiac death in cardiomyopathies: acting upon "acceptable" risk in the personalized medicine era. Heart Fail Rev 2022; 27:1749-1759. [PMID: 35083629 DOI: 10.1007/s10741-021-10198-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Patients with cardiomyopathies are confronted with the risk of sudden cardiac death (SCD) throughout their lifetime. Despite the fact that SCD is relatively rare, prognostic stratification is an integral part of physician-patient discussion, with the goal of risk modification and prevention. The current approach is based on a concept of "acceptable risk." However, there are intrinsic problems with an algorithm-based approach to risk management, magnified by the absence of robust evidence underlying clinical decision support tools, which can make high- versus low-risk classifications arbitrary. Strategies aimed at risk reduction range from selecting patients for an implantable cardioverter defibrillator (ICD) to disqualification from competitive sports. These clinical options, especially when implying the use of finite financial resources, are often delivered from the physician's perspective citing decision-making algorithms. When the burden of intervention-related risks or financial costs is deemed higher than an "acceptable risk" of SCD, the patient's perspective may not be appropriately considered. Designating a numeric threshold of "acceptable risk" has ethical implications. One could reasonably ask "acceptable to whom?" In an era when individual choice and autonomy are pillars of the physician-patient relationship, the subjective aspects of perceived risk should be acknowledged and be part of shared decision-making. This is particularly true when the lack of a strong scientific evidence base makes a dichotomous algorithm-driven approach suboptimal for unmitigated translation to clinical practice.
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Affiliation(s)
- Gherardo Finocchiaro
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK. .,King's College London, London, UK. .,Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK. .,Cardiovascular Clinical Academic Group, St George's, University of London, London, UK.
| | - Emma F Magavern
- The London School of Medicine and Dentistry, William Harvey Research Institute, Barts, London, UK.,Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | | | - Niccolo' Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Gerald Carr-White
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK.,King's College London, London, UK
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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5
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Casella M, Gasperetti A, Gaetano F, Busana M, Sommariva E, Catto V, Sicuso R, Rizzo S, Conte E, Mushtaq S, Andreini D, Di Biase L, Carbucicchio C, Natale A, Basso C, Tondo C, Dello Russo A. Long-term follow-up analysis of a highly characterized arrhythmogenic cardiomyopathy cohort with classical and non-classical phenotypes-a real-world assessment of a novel prediction model: does the subtype really matter. Europace 2021; 22:797-805. [PMID: 31942607 DOI: 10.1093/europace/euz352] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/09/2019] [Indexed: 01/22/2023] Open
Abstract
AIMS To provide long-term outcome data on arrhythmogenic cardiomyopathy (ACM) patients with non-classical forms [left dominant ACM (LD-ACM) and biventricular ACM (Bi-ACM)] and an external validation of a recently proposed algorithm for ventricular arrhythmia (VA) prediction in ACM patients. METHODS AND RESULTS Demographic, clinical, and outcome data were retrieved from all ACM patients encountered at our institution. Patients were classified according to disease phenotype (R-ACM; Bi-ACM; LD-ACM). Overall and by phenotype long-term survival were calculated; the novel Cadrin-Tourigny et al. algorithm was used to calculate the a priori predicted VA risk, and it was compared with the observed outcome to test its reliability. One hundred and one patients were enrolled; three subgroups were defined (R-ACM, n = 68; Bi-ACM, n = 14; LD-ACM, n = 19). Over a median of 5.41 (2.59-8.37) years, the non-classical form cohort experienced higher rates of VAs than the classical form [5-year freedom from VAs: 0.58 (0.43-0.78) vs. 0.76 (0.66-0.89), P = 0.04]. The Cadrin-Tourigny et al. predictive model adequately described the overall cohort risk [mean observed-predicted risk difference (O-PRD): +6.7 (-4.3, +17.7) %, P = 0.19]; strafing by subgroup, excellent goodness-of-fit was demonstrated for the R-ACM subgroup (mean O-PRD, P = 0.99), while in the Bi-ACM and LD-ACM ones the real observed risk appeared to be underestimated [mean O-PRD: -20.0 (-1.1, -38.9) %, P < 0.0001; -22.6 (-7.8, -37.5) %, P < 0.0001, respectively]. CONCLUSION Non-classical ACM forms appear more prone to VAs than classical forms. The novel prediction model effectively predicted arrhythmic risk in the classical R-ACM cohort, but seemed to underestimate it in non-classical forms.
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Affiliation(s)
- Michela Casella
- Dipartimento di Aritmologia, Centro Cardiologico Monzino IRCCS, via Carlo Parea 4, 20100 Milano (MI), Italy
| | - Alessio Gasperetti
- Dipartimento di Aritmologia, Centro Cardiologico Monzino IRCCS, via Carlo Parea 4, 20100 Milano (MI), Italy
| | - Fassini Gaetano
- Dipartimento di Aritmologia, Centro Cardiologico Monzino IRCCS, via Carlo Parea 4, 20100 Milano (MI), Italy
| | - Mattia Busana
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Elena Sommariva
- Unit of Vascular Biology and Regenerative Medicine, Centro Cardiologico Monzino IRCCS, Milano (MI), Italy
| | - Valentina Catto
- Dipartimento di Aritmologia, Centro Cardiologico Monzino IRCCS, via Carlo Parea 4, 20100 Milano (MI), Italy
| | - Rita Sicuso
- Dipartimento di Aritmologia, Centro Cardiologico Monzino IRCCS, via Carlo Parea 4, 20100 Milano (MI), Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova (PD), Italy
| | - Edoardo Conte
- Dipartimento di Imaging Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milano (MI), Italy
| | - Saima Mushtaq
- Dipartimento di Imaging Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milano (MI), Italy
| | - Daniele Andreini
- Dipartimento di Imaging Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milano (MI), Italy
| | - Luigi Di Biase
- Montefiore Medical Center, Albert-Einstein College of Medicine, Bronx, NY, USA
| | - Corrado Carbucicchio
- Dipartimento di Aritmologia, Centro Cardiologico Monzino IRCCS, via Carlo Parea 4, 20100 Milano (MI), Italy
| | - Andrea Natale
- Texas Cardiac Arrhyhtmia Institute (TCAI) at St. David's Hospital, Austin, TX, USA
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova (PD), Italy
| | - Claudio Tondo
- Dipartimento di Aritmologia, Centro Cardiologico Monzino IRCCS, via Carlo Parea 4, 20100 Milano (MI), Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano (MI), Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechic University, University Hospital "Ospedali Riuniti", Ancona (AN), Italy
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6
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Zhang N, Song Y, Hua W, Hu Y, Chen L, Cai M, Niu H, Cai C, Gu M, Zhao S, Zhang S. Left ventricular involvement assessed by LGE-CMR in predicting the risk of adverse outcomes of arrhythmogenic cardiomyopathy with ICDs. Int J Cardiol 2021; 337:79-85. [PMID: 33839174 DOI: 10.1016/j.ijcard.2021.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is characterized by a high incidence of ventricular tachyarrhythmia and sudden death. Implantable cardioverter-defibrillator (ICD) implantation is the cornerstone of management. OBJECTIVE This study aims to reveal the prognostic value of the contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) amount in predicting varying lethal outcomes among ACM patients with ICDs. METHODS The 88 patients with definite ACM who were all referred for contrast-enhanced CMR received an ICD and were followed up for a median of 4.0 years. RESULTS Fifty-four patients had no left ventricular (LV) involvement and sixteen had an LV LGE amount > 15%. During the follow-up time, appropriate ICD therapy was seen in 57, electrical storm (ES) in 19, and cardiac death in 9 patients. Compared with those without LV involvement, patients with LV LGE amount > 15% had a higher risk of cardiac death (log-rank P = 0.021). LV LGE amount was associated with an increased risk of ICD therapy [adjusted hazard ratio (HR) 1.035, 95% confidence interval (CI) 1.008-1.062, P = 0.010], and cardiac death (adjusted HR 1.082, 95% 1.006-1.164, P = 0.034), independently of LV ejection fraction. LV LGE mass of >15% demonstrated an over 2-fold increase in ICD therapy (adjusted HR 2.180, 95%CI 1.058-4.488, P = 0.035) and an over 7-fold increase in cardiac death (unadjusted HR 7.198, 95%CI 1.399-37.043, P = 0.018) than those without LV involvement, respectively. CONCLUSIONS The LV LGE-CMR in ACM shows a dose-dependent association with ICD therapy and cardiac death. And LV LGE amount of >15% is a strong predictor.
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Affiliation(s)
- Nixiao Zhang
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yanyan Song
- Departments of CMR, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Yiran Hu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Liang Chen
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Minsi Cai
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Hongxia Niu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chi Cai
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Min Gu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shihua Zhao
- Departments of CMR, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shu Zhang
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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7
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Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A, Bourfiss M, Fortier A, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, van der Heijden JF, Tandri H, Jongbloed JDH, Guertin MC, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2020; 40:1850-1858. [PMID: 30915475 PMCID: PMC6568197 DOI: 10.1093/eurheartj/ehz103] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 03/01/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Julia Cadrin-Tourigny
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Laurens P Bosman
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Øyvind H Lie
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Anneli Svensson
- Department of Cardiology, University Hosptial of Linköping, S-581 85 Linköping, Sweden
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands.,Faculty of Population Health Sciences, Institute of Cardiovascular Science, Institute of Health Informatics, University College London, 69-75 Chenies Mews, London, UK
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia 211 - 1033 Davie Street, Vancouver, BC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Stephen Chelko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Jane E Crosson
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, GD, Rotterdam, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - J Peter van Tintelen
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD Amsterdam, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University Hosptial, Lund, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Paul Khairy
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Richard N W Hauer
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Anneline S J M Te Riele
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
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8
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Gasperetti A, Dello Russo A, Busana M, Dessanai M, Pizzamiglio F, Saguner AM, te Riele AS, Sommariva E, Vettor G, Bosman L, Duru F, Zeppilli P, Di Biase L, Natale A, Tondo C, Casella M. Novel risk calculator performance in athletes with arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2020; 17:1251-1259. [DOI: 10.1016/j.hrthm.2020.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
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9
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Frommeyer G, Reinke F, Andresen D, Kleemann T, Spitzer SG, Jehle J, Brachmann J, Stellbrink C, Hochadel M, Senges J, Eckardt L. Implantable cardioverter defibrillators in patients with electrical heart disease and hypertrophic cardiomyopathy: data from the German device registry. Clin Res Cardiol 2019; 109:508-512. [DOI: 10.1007/s00392-019-01532-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022]
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10
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Orgeron GM, Te Riele A, Tichnell C, Wang W, Murray B, Bhonsale A, Judge DP, Kamel IR, Zimmerman SL, Tandri H, Calkins H, James CA. Performance of the 2015 International Task Force Consensus Statement Risk Stratification Algorithm for Implantable Cardioverter-Defibrillator Placement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. Circ Arrhythm Electrophysiol 2018; 11:e005593. [PMID: 29453325 DOI: 10.1161/circep.117.005593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular arrhythmias are a feared complication of arrhythmogenic right ventricular dysplasia/cardiomyopathy. In 2015, an International Task Force Consensus Statement proposed a risk stratification algorithm for implantable cardioverter-defibrillator placement in arrhythmogenic right ventricular dysplasia/cardiomyopathy. METHODS AND RESULTS To evaluate performance of the algorithm, 365 arrhythmogenic right ventricular dysplasia/cardiomyopathy patients were classified as having a Class I, IIa, IIb, or III indication per the algorithm at baseline. Survival free from sustained ventricular arrhythmia (VT/VF) in follow-up was the primary outcome. Incidence of ventricular fibrillation/flutter cycle length <240 ms was also assessed. Two hundred twenty-four (61%) patients had a Class I implantable cardioverter-defibrillator indication; 80 (22%), Class IIa; 54 (15%), Class IIb; and 7 (2%), Class III. During a median 4.2 (interquartile range, 1.7-8.4)-year follow-up, 190 (52%) patients had VT/VF and 60 (16%) had ventricular fibrillation/flutter. Although the algorithm appropriately differentiated risk of VT/VF, incidence of VT/VF was underestimated (observed versus expected: 29.6 [95% confidence interval, 25.2-34.0] versus >10%/year Class I; 15.5 [confidence interval 11.1-21.6] versus 1% to 10%/year Class IIa). In addition, the algorithm did not differentiate survival free from ventricular fibrillation/flutter between Class I and IIa patients (P=0.97) or for VT/VF in Class I and IIa primary prevention patients (P=0.22). Adding Holter results (<1000 premature ventricular contractions/24 hours) to International Task Force Consensus classification differentiated risks. CONCLUSIONS While the algorithm differentiates arrhythmic risk well overall, it did not distinguish ventricular fibrillation/flutter risks of patients with Class I and IIa implantable cardioverter-defibrillator indications. Limited differentiation was seen for primary prevention cases. As these are vital uncertainties in clinical decision-making, refinements to the algorithm are suggested prior to implementation.
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Affiliation(s)
- Gabriela M Orgeron
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Anneline Te Riele
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Crystal Tichnell
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Weijia Wang
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Brittney Murray
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Aditya Bhonsale
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Daniel P Judge
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Ihab R Kamel
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Stephan L Zimmerman
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Harikrishna Tandri
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Hugh Calkins
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.)
| | - Cynthia A James
- From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.).
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11
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Bermúdez-Jiménez FJ, Carriel V, Brodehl A, Alaminos M, Campos A, Schirmer I, Milting H, Abril BÁ, Álvarez M, López-Fernández S, García-Giustiniani D, Monserrat L, Tercedor L, Jiménez-Jáimez J. Novel Desmin Mutation p.Glu401Asp Impairs Filament Formation, Disrupts Cell Membrane Integrity, and Causes Severe Arrhythmogenic Left Ventricular Cardiomyopathy/Dysplasia. Circulation 2017; 137:1595-1610. [PMID: 29212896 DOI: 10.1161/circulationaha.117.028719] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Desmin (DES) mutations cause severe skeletal and cardiac muscle disease with heterogeneous phenotypes. Recently, DES mutations were described in patients with inherited arrhythmogenic right ventricular cardiomyopathy/dysplasia, although their cellular and molecular pathomechanisms are not precisely known. Our aim is to describe clinically and functionally the novel DES-p.Glu401Asp mutation as a cause of inherited left ventricular arrhythmogenic cardiomyopathy/dysplasia. METHODS We identified the novel DES mutation p.Glu401Asp in a large Spanish family with inherited left ventricular arrhythmogenic cardiomyopathy/dysplasia and a high incidence of adverse cardiac events. A full clinical evaluation was performed on all mutation carriers and noncarriers to establish clinical and genetic cosegregation. In addition, desmin, and intercalar disc-related proteins expression were histologically analyzed in explanted cardiac tissue affected by the DES mutation. Furthermore, mesenchymal stem cells were isolated and cultured from 2 family members with the DES mutation (1 with mild and 1 with severe symptomatology) and a member without the mutation (control) and differentiated ex vivo to cardiomyocytes. Then, important genes related to cardiac differentiation and function were analyzed by real-time quantitative polymerase chain reaction. Finally, the p.Glu401Asp mutated DES gene was transfected into cell lines and analyzed by confocal microscopy. RESULTS Of the 66 family members screened for the DES-p.Glu401Asp mutation, 23 of them were positive, 6 were obligate carriers, and 2 were likely carriers. One hundred percent of genotype-positive patients presented data consistent with inherited arrhythmogenic cardiomyopathy/dysplasia phenotype with variable disease severity expression, high-incidence of sudden cardiac death, and absence of skeletal myopathy or conduction system disorders. Immunohistochemistry was compatible with inherited arrhythmogenic cardiomyopathy/dysplasia, and the functional study showed an abnormal growth pattern and cellular adhesion, reduced desmin RNA expression, and some other membrane proteins, as well, and desmin aggregates in transfected cells expressing the mutant desmin. CONCLUSIONS The DES-p.Glu401Asp mutation causes predominant inherited left ventricular arrhythmogenic cardiomyopathy/dysplasia with a high incidence of adverse clinical events in the absence of skeletal myopathy or conduction system disorders. The pathogenic mechanism probably corresponds to an alteration in desmin dimer and oligomer assembly and its connection with membrane proteins within the intercalated disc.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/physiopathology
- Cardiomyopathies/diagnosis
- Cardiomyopathies/genetics
- Cardiomyopathies/physiopathology
- Cell Differentiation/genetics
- Cells, Cultured
- Child
- Desmin/genetics
- Desmin/metabolism
- Electrocardiography
- Female
- Genetic Predisposition to Disease
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/physiopathology
- Heart Ventricles/abnormalities
- Heart Ventricles/metabolism
- Heart Ventricles/physiopathology
- Heredity
- Heterozygote
- Humans
- Magnetic Resonance Imaging
- Male
- Mesenchymal Stem Cells/metabolism
- Mesenchymal Stem Cells/pathology
- Middle Aged
- Mutation
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Pedigree
- Phenotype
- Spain
- Young Adult
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Affiliation(s)
- Francisco José Bermúdez-Jiménez
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.).
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Víctor Carriel
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Andreas Brodehl
- Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (A.B., I.S., H.M.)
| | - Miguel Alaminos
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Antonio Campos
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Ilona Schirmer
- Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (A.B., I.S., H.M.)
| | - Hendrik Milting
- Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (A.B., I.S., H.M.)
| | - Beatriz Álvarez Abril
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Miguel Álvarez
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Silvia López-Fernández
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | | | - Lorenzo Monserrat
- Cardiology Department, Health in Code, A Coruña, Spain (D.G.-G., L.M.)
| | - Luis Tercedor
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Juan Jiménez-Jáimez
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
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Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by ventricular arrhythmias and an increased risk of sudden cardiac death. Although structural abnormalities of the right ventricle predominate, it is well recognized that left ventricular involvement is common, particularly in advanced disease, and that left-dominant forms occur. The pathological characteristic of ARVC is myocyte loss with fibrofatty replacement. Since the first detailed clinical description of the disorder in 1982, significant advances have been made in understanding this disease. Once the diagnosis of ARVC is established, the single most important clinical decision is whether a particular patient's sudden cardiac death risk is sufficient to justify placement of an implantable cardioverter-defibrillator. The importance of this decision reflects the fact that ARVC is a common cause of sudden death in young people and that sudden death may be the first manifestation of the disease. This decision is particularly important because these are often young patients who are expected to live for many years. Although an implantable cardioverter-defibrillator can save lives in individuals with this disease, it is also well recognized that implantable cardioverter-defibrillator therapy is associated with both short- and long-term complications. Decisions about the placement of an implantable cardioverter-defibrillator are based on an estimate of a patient's risk of sudden cardiac death, as well as their preferences and values. The primary purpose of this article is to provide a review of the literature that concerns risk stratification in patients with ARVC and to place this literature in the framework of the 3 authors' considerable lifetime experiences in caring for patients with ARVC. The most important parameters to consider when determining arrhythmic risk include electric instability, including the frequency of premature ventricular contractions and sustained ventricular arrhythmia; proband status; extent of structural disease; cardiac syncope; male sex; the presence of multiple mutations or a mutation in TMEM43; and the patient's willingness to restrict exercise and to eliminate participation in competitive or endurance exercise.
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Affiliation(s)
- Hugh Calkins
- Cardiology Division, Johns Hopkins Medical Institutions, Baltimore, MD (H.C.)
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy (D.C.)
| | - Frank Marcus
- University of Arizona College of Medicine, Tucson (F.M.)
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13
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Orgeron GM, James CA, Te Riele A, Tichnell C, Murray B, Bhonsale A, Kamel IR, Zimmerman SL, Judge DP, Crosson J, Tandri H, Calkins H. Implantable Cardioverter-Defibrillator Therapy in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Predictors of Appropriate Therapy, Outcomes, and Complications. J Am Heart Assoc 2017; 6:JAHA.117.006242. [PMID: 28588093 PMCID: PMC5669204 DOI: 10.1161/jaha.117.006242] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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<0.001), inducibility on electrophysiology study (HR: 3.14; 95% CI, 1.95–5.05; P<0.001), male sex (HR: 1.62; 95% CI, 1.20–2.19; 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<0.036), and male sex (HR: 1.73; 95% CI, 1.01–2.97; 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<0.014) remained as independent predictors of ventricular fibrillation/flutter. Complications occurred in 66 participants (21%), and 64 (21%) had inappropriate 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.
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Affiliation(s)
- Gabriela M Orgeron
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Anneline Te Riele
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD
| | | | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Jane Crosson
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
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14
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Herman AR, Gardner M, Steinberg C, Yeung-Lai-Wah JA, Healey JS, Leong-Sit P, Krahn AD, Chakrabarti S. Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2016; 13:1964-70. [DOI: 10.1016/j.hrthm.2016.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Indexed: 11/26/2022]
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15
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Hodgkinson KA, Howes A, Boland P, Shen XS, Stuckless S, Young TL, Curtis F, Collier A, Parfrey PS, Connors SP. Long-Term Clinical Outcome of Arrhythmogenic Right Ventricular Cardiomyopathy in Individuals With a p.S358L Mutation in
TMEM43
Following Implantable Cardioverter Defibrillator Therapy. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003589. [DOI: 10.1161/circep.115.003589] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background—
We previously showed a survival benefit of the implantable cardioverter defibrillator (ICD) in males with arrhythmogenic right ventricular cardiomyopathy caused by a p.S358L mutation in
TMEM43
. We present long-term data (median follow-up 8.5years) after ICD for primary (PP) and secondary prophylaxis in males and females, determine whether ICD discharges for ventricular tachycardia/ventricular fibrillation were equivalent to an aborted death, and assess relevant clinical predictors.
Methods and Results—
We studied 24 multiplex families segregating an autosomal dominant p.S358L mutation in
TMEM43
. We compared survival in 148 mutation carriers with an ICD to 148 controls matched for age, sex, disease status, and family. Of 80 male mutation carriers with ICDs (median age at implantation 31 years), 61 (76%) were for PP; of 68 females (median age at implantation 43 years), 66 (97%) were for PP. In males, irrespective of indication, survival was better in the ICD groups compared with control groups (relative risk 9.3 [95% confidence interval 3.3–26] for PP and 9.7 [95% confidence interval 3.2–29.6] for secondary prophylaxis). For PP females, the relative risk was 3.6 (95% confidence interval 1.3–9.5). ICD discharge-free survival for ventricular tachycardia/ventricular fibrillation ≥240 beats per minute was equivalent to the control survival rate. Ectopy (≥1000 premature ventricular complexes/24 hours) was the only independent clinical predictor of ICD discharge in males, and no predictor was identified in females.
Conclusions—
ICD therapy is indicated for PP in postpubertal males and in females ≥30 years with the p.S358L
TMEM43
mutation. ICD termination of rapid ventricular tachycardia/ventricular fibrillation can reasonably be considered an aborted death.
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Affiliation(s)
- Kathleen A. Hodgkinson
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - A.J. Howes
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Paul Boland
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Xiou Seegar Shen
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Susan Stuckless
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Terry-Lynn Young
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Fiona Curtis
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Ashley Collier
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Patrick S. Parfrey
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
| | - Sean P. Connors
- From the Clinical Epidemiology Unit, Discipline of Medicine (K.A.H., S.S., P.S.P.), Discipline of Genetics (K.A.H., T.-L.Y., F.C., A.C.), and Division of Cardiology (A.J.H., P.B., X.S.S., S.P.C.), Faculty of Medicine, Memorial University, Health Sciences Centre, St John’s, NL, Canada
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16
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Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: A systematic review and meta-analysis of inappropriate shocks and complications. Heart Rhythm 2015; 13:443-54. [PMID: 26385533 DOI: 10.1016/j.hrthm.2015.09.010] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are implanted with the intention to prolong life in selected patients with inherited arrhythmia syndromes, but ICD implantation is also associated with inappropriate shocks and complications. OBJECTIVE We aimed to quantify the rate of inappropriate shocks and other ICD-related complications to be able to weigh benefit and harm in these patients. METHODS We performed a systematic review and meta-analysis of inappropriate shock and/or other ICD-related complication rates, including ICD-related mortality, in patients with inherited arrhythmia syndromes, that is, arrhythmogenic right ventricular cardiomyopathy/dysplasia, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, dilated cardiomyopathy due to a mutation in the lamin A/C gene, long QT syndrome, and short QT syndrome. We searched MEDLINE and EMBASE from inception to May 30, 2014. RESULTS Of 2471 unique citations, 63 studies comprising 4916 patients with inherited arrhythmia syndromes (mean age of 39 ± 15 years) were included. Inappropriate shocks occurred in 20% of patients (crude annual rate of 4.7% per year), with a significantly higher rate in studies published before 2008 (6.1% per year vs 4.1% per year). Moreover, 22% experienced ICD-related complications (4.4% per year) and there was a 0.5% ICD-related mortality (0.08% per year). CONCLUSION ICD implantation carries a significant risk of inappropriate shocks and inhospital and postdischarge complications in relatively young patients with inherited arrhythmia syndromes. These data can be used to better inform patients and physicians about the expected risk of adverse ICD events and thereby facilitate shared decision making.
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17
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Mast TP, Teske AJ, vd Heijden JF, Groeneweg JA, Te Riele AS, Velthuis BK, Hauer RN, Doevendans PA, Cramer MJ. Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Assessed by Echocardiography Predicts Adverse Clinical Outcome. J Am Soc Echocardiogr 2015; 28:1103-13.e9. [DOI: 10.1016/j.echo.2015.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Indexed: 11/29/2022]
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18
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Corrado D, Wichter T, Link MS, Hauer R, Marchlinski F, Anastasakis A, Bauce B, Basso C, Brunckhorst C, Tsatsopoulou A, Tandri H, Paul M, Schmied C, Pelliccia A, Duru F, Protonotarios N, Estes NAM, McKenna WJ, Thiene G, Marcus FI, Calkins H. Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement. Eur Heart J 2015. [PMID: 26216920 PMCID: PMC4670964 DOI: 10.1093/eurheartj/ehv162] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | - Thomas Wichter
- Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany
| | - Mark S Link
- New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA, USA
| | - Richard Hauer
- ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | | | - Aris Anastasakis
- First Cardiology Department, University of Athens, Medical School, Athens, Greece
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | | | | | | | | | - Christian Schmied
- Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Firat Duru
- Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
| | | | - N A Mark Estes
- New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
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19
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Corrado D, Wichter T, Link MS, Hauer RNW, Marchlinski FE, Anastasakis A, Bauce B, Basso C, Brunckhorst C, Tsatsopoulou A, Tandri H, Paul M, Schmied C, Pelliccia A, Duru F, Protonotarios N, Estes NM, McKenna WJ, Thiene G, Marcus FI, Calkins H. Treatment of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: An International Task Force Consensus Statement. Circulation 2015. [PMID: 26216213 PMCID: PMC4521905 DOI: 10.1161/circulationaha.115.017944] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Domenico Corrado
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.).
| | - Thomas Wichter
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Mark S Link
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Richard N W Hauer
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Frank E Marchlinski
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Aris Anastasakis
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Barbara Bauce
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Cristina Basso
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Corinna Brunckhorst
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Adalena Tsatsopoulou
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Harikrishna Tandri
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Matthias Paul
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Christian Schmied
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Antonio Pelliccia
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Firat Duru
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Nikos Protonotarios
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Na Mark Estes
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - William J McKenna
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Gaetano Thiene
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Frank I Marcus
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Hugh Calkins
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
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20
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Saguner AM, Ganahl S, Kraus A, Baldinger SH, Akdis D, Saguner AR, Wolber T, Haegeli LM, Steffel J, Krasniqi N, Lüscher TF, Tanner FC, Brunckhorst C, Duru F. Electrocardiographic features of disease progression in arrhythmogenic right ventricular cardiomyopathy/dysplasia. BMC Cardiovasc Disord 2015; 15:4. [PMID: 25599583 PMCID: PMC4407546 DOI: 10.1186/1471-2261-15-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/09/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is considered a progressive cardiomyopathy. However, data on the clinical features of disease progression are limited. The aim of this study was to assess 12-lead surface electrocardiographic (ECG) changes during long-term follow-up, and to compare these findings with echocardiographic data in our large cohort of patients with ARVC/D. METHODS Baseline and follow-up ECGs of 111 patients from three tertiary care centers in Switzerland were systematically analyzed with digital calipers by two blinded observers, and correlated with findings from transthoracic echocardiography. RESULTS The median follow-up was 4 years (IQR 1.9-9.2 years). ECG progression was significant for epsilon waves (baseline 14% vs. follow-up 31%, p = 0.01) and QRS duration (111 ms vs. 114 ms, p = 0.04). Six patients with repolarization abnormalities according to the 2010 Task Force Criteria at baseline did not display these criteria at follow-up, whereas in all patients with epsilon waves at baseline these depolarization abnormalities also remained at follow-up. T wave inversions in inferior leads were common (36% of patients at baseline), and were significantly associated with major repolarization abnormalities (p = 0.02), extensive echocardiographic right ventricular involvement (p = 0.04), T wave inversions in lateral precordial leads (p = 0.05), and definite ARVC/D (p = 0.05). CONCLUSIONS Our data supports the concept that ARVC/D is generally progressive, which can be detected by 12-lead surface ECG. Repolarization abnormalities may disappear during the course of the disease. Furthermore, the presence of T wave inversions in inferior leads is common in ARVC/D.
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Affiliation(s)
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- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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21
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Usefulness of electrocardiographic parameters for risk prediction in arrhythmogenic right ventricular dysplasia. Am J Cardiol 2014; 113:1728-34. [PMID: 24792740 DOI: 10.1016/j.amjcard.2014.02.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 12/29/2022]
Abstract
The value of electrocardiographic findings predicting adverse outcome in patients with arrhythmogenic right ventricular dysplasia (ARVD) is not well known. We hypothesized that ventricular depolarization and repolarization abnormalities on the 12-lead surface electrocardiogram (ECG) predict adverse outcome in patients with ARVD. ECGs of 111 patients screened for the 2010 ARVD Task Force Criteria from 3 Swiss tertiary care centers were digitized and analyzed with a digital caliper by 2 independent observers blinded to the outcome. ECGs were compared in 2 patient groups: (1) patients with major adverse cardiovascular events (MACE: a composite of cardiac death, heart transplantation, survived sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or arrhythmic syncope) and (2) all remaining patients. A total of 51 patients (46%) experienced MACE during a follow-up period with median of 4.6 years (interquartile range 1.8 to 10.0). Kaplan-Meier analysis revealed reduced times to MACE for patients with repolarization abnormalities according to Task Force Criteria (p = 0.009), a precordial QRS amplitude ratio (∑QRS mV V1 to V3/∑QRS mV V1 to V6) of ≤ 0.48 (p = 0.019), and QRS fragmentation (p = 0.045). In multivariable Cox regression, a precordial QRS amplitude ratio of ≤ 0.48 (hazard ratio [HR] 2.92, 95% confidence interval [CI] 1.39 to 6.15, p = 0.005), inferior leads T-wave inversions (HR 2.44, 95% CI 1.15 to 5.18, p = 0.020), and QRS fragmentation (HR 2.65, 95% CI 1.1 to 6.34, p = 0.029) remained as independent predictors of MACE. In conclusion, in this multicenter, observational, long-term study, electrocardiographic findings were useful for risk stratification in patients with ARVD, with repolarization criteria, inferior leads TWI, a precordial QRS amplitude ratio of ≤ 0.48, and QRS fragmentation constituting valuable variables to predict adverse outcome.
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22
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Saguner AM, Brunckhorst C, Duru F. Arrhythmogenic ventricular cardiomyopathy: A paradigm shift from right to biventricular disease. World J Cardiol 2014; 6:154-174. [PMID: 24772256 PMCID: PMC3999336 DOI: 10.4330/wjc.v6.i4.154] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic ventricular cardiomyopathy (AVC) is generally referred to as arrhythmogenic right ventricular (RV) cardiomyopathy/dysplasia and constitutes an inherited cardiomyopathy. Affected patients may succumb to sudden cardiac death (SCD), ventricular tachyarrhythmias (VTA) and heart failure. Genetic studies have identified causative mutations in genes encoding proteins of the intercalated disk that lead to reduced myocardial electro-mechanical stability. The term arrhythmogenic RV cardiomyopathy is somewhat misleading as biventricular involvement or isolated left ventricular (LV) involvement may be present and thus a broader term such as AVC should be preferred. The diagnosis is established on a point score basis according to the revised 2010 task force criteria utilizing imaging modalities, demonstrating fibrous replacement through biopsy, electrocardiographic abnormalities, ventricular arrhythmias and a positive family history including identification of genetic mutations. Although several risk factors for SCD such as previous cardiac arrest, syncope, documented VTA, severe RV/LV dysfunction and young age at manifestation have been identified, risk stratification still needs improvement, especially in asymptomatic family members. Particularly, the role of genetic testing and environmental factors has to be further elucidated. Therapeutic interventions include restriction from physical exercise, beta-blockers, sotalol, amiodarone, implantable cardioverter-defibrillators and catheter ablation. Life-long follow-up is warranted in symptomatic patients, but also asymptomatic carriers of pathogenic mutations.
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23
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Nitta E, Yoshitomi H, Sugamori T, Fukuma A, Shibata H, Adachi T, Ito S, Takahashi N, Nagai A, Tanabe K. A case of arrhythmogenic right ventricular cardiomyopathy in a 70-year-old patient. J Med Ultrason (2001) 2014; 41:73-6. [DOI: 10.1007/s10396-013-0455-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
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Silvano M, Corrado D, Köbe J, Mönnig G, Basso C, Thiene G, Eckardt L. Risk stratification in arrhythmogenic right ventricular cardiomyopathy. Herzschrittmacherther Elektrophysiol 2013; 24:202-8. [PMID: 24113835 DOI: 10.1007/s00399-013-0291-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 12/20/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy characterized by myocyte death and fibrofatty replacement mostly in the right ventricle. It is a leading cause of sudden cardiac death (SCD) in individuals under the age of 35 years. The main goal in the treatment of the disease is the prevention of SCD. An implantable cardioverter-defibrillator (ICD) is the only proven life-saving therapeutic option able to improve survival in ARVC patients. This therapy is not free from side effects and it accounts for a relatively high rate of morbidity because of the occurrence of inappropriate ICD interventions and of complications, both at implantation and during the follow-up. In recent years, the approach to ICD implantation has been changing on the basis of new emerging data on risk stratification. The usefulness of ICD implantation for secondary prevention has been definitively proven; the most challenging question is how to treat patients with no history of previous cardiac arrest or hemodynamically unstable ventricular tachycardia (VT). The value of ECG abnormalities, syncope, VT, and right/left ventricular involvement as predictors of SCD has been assessed in different studies with the purpose of better defining risk stratification in ARVC. Nevertheless, in spite of the growing amount of data, primary prevention in ARVC patients remains mostly an individual decision.
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Affiliation(s)
- M Silvano
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova Medical School, Padova, Italy
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25
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Basso C, Corrado D, Bauce B, Thiene G. Arrhythmogenic right ventricular cardiomyopathy. Circ Arrhythm Electrophysiol 2012; 5:1233-46. [PMID: 23022706 DOI: 10.1161/circep.111.962035] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Cristina Basso
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padua, Italy.
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