Clinical role of atrial arrhythmias in patients with arrhythmogenic right ventricular dysplasia

Saguner, Ardan; Ganahl, Sabrina; Kraus, Andrea; Baldinger, Samuel Hannes; Medeiros Domingo, Argelia; Saguner, Arhan R; Mueller-Burri, Stephan; Wolber, Thomas; Haegeli, Laurent M; Nazmi, Krasniqi; Tanner, Felix C; Steffel, Jan; Brunckhorst, Corinna; Firat, Duru (2014). Clinical role of atrial arrhythmias in patients with arrhythmogenic right ventricular dysplasia. Circulation journal, 78(12), pp. 2854-2861. Japanese Circulation Society 10.1253/circj.CJ-14-0474

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BACKGROUND:

The clinical role of atrial fibrillation/atrial flutter (AF-AFl) and variables predicting these arrhythmias are not well defined in patients with arrhythmogenic right ventricular dysplasia (ARVD). We hypothesized that transthoracic echocardiography (TTE) and 12-lead electrocardiography (ECG) would be helpful in predicting AF-AFl in these patients. METHODS AND RESULTS: ECGs and TTEs of 90 patients diagnosed with definite or borderline ARVD (2010 Task Force Criteria) were analyzed. Data were compared in (1) patients with AF-AFl and (2) all other patients. A total of 18 (20%) patients experienced AF-AFl during a median follow-up of 5.8 years (interquartile range 2.0-10.4). Kaplan-Meier analysis revealed reduced times to AF-AFl among patients with echocardiographic RV fractional area change <27% (P<0.001), left atrial diameter ≥24.4 mm/m(2)(parasternal long-axis, P=0.001), and right atrial short-axis diameter ≥22.1 mm/m(2)(apical 4-chamber view, P=0.05). From all ECG variables, P mitrale conferred the highest hazard ratio (3.37, 95% confidence interval 0.92-12.36, P=0.067). Five patients with AF-AFl experienced inappropriate implantable cardioverter-defibrillator (ICD) shocks compared with 4 without AF-AFl (36% vs. 9%, P=0.03). AF-AFl was more prevalent in heart-transplant patients and those who died of cardiac causes (56% vs. 16%, P=0.014).

CONCLUSIONS:

AF-AFl is associated with inappropriate ICD shocks, heart transplantation, and cardiac death in patients with ARVD. Evidence of reduced RV function and atrial dilation helps to identify the ARVD patients at increased risk for AF-AFl.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Baldinger, Samuel Hannes and Medeiros Domingo, Argelia

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1346-9843

Publisher:

Japanese Circulation Society

Language:

English

Submitter:

Argelia Medeiros Domingo

Date Deposited:

03 Mar 2015 09:26

Last Modified:

28 Oct 2019 22:59

Publisher DOI:

10.1253/circj.CJ-14-0474

PubMed ID:

25327952

BORIS DOI:

10.7892/boris.63876

URI:

https://boris.unibe.ch/id/eprint/63876

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