Incidence and predictors of implantable cardioverter-defibrillator therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing implantable cardioverter-defibrillator implantation for primary prevention

Aditya Bhonsale, Cynthia A. James, Crystal Tichnell, Brittney Murray, Dmitri Gagarin, Binu Philips, Darshan Dalal, Ryan Tedford, Stuart D. Russell, Theodore Abraham, Harikrishna Tandri, Daniel P. Judge, Hugh Calkins

Research output: Contribution to journalArticlepeer-review

161 Scopus citations

Abstract

Objectives: The purpose of this study was to define the incidence and predictors of implantable cardioverter-defibrillator (ICD) therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) after placement of an ICD for primary prevention. Background: Patients with a diagnosis of ARVD/C often receive an ICD for prevention of sudden cardiac death. Methods: Patients (n = 84) from the Johns Hopkins registry with definite or probable ARVD/C who underwent ICD implantation for primary prevention were studied. Detailed phenotypic, genotype, and ICD event information was obtained and appropriate ICD therapies were adjudicated based on intracardiac electrograms. Results: Over a mean follow-up of 4.7 ± 3.4 years, appropriate ICD therapy was seen in 40 patients (48%), of whom 16 (19%) received interventions for potentially fatal ventricular fibrillation/flutter episodes. Proband status (p < 0.001), inducibility at electrophysiologic study (p = 0.005), presence of nonsustained ventricular tachycardia (p < 0.001), and Holter premature ventricular complex count >1,000/24 h (p = 0.024) were identified as significant predictors of appropriate ICD therapy. The 5-year survival free of appropriate ICD therapy for patients with 1, 2, 3, and 4 risk factors was 100%, 83%, 21%, and 15%, respectively. Inducibility at electrophysiologic study (hazard ratio: 4.5, 95% confidence interval: 1.4 to 15, p = 0.013) and nonsustained ventricular tachycardia (hazard ratio: 10.5, 95% confidence interval: 2.4 to 46.2, p = 0.002) remained as significant predictors on multivariable analysis. Conclusions: Nearly one-half of the ARVD/C patients with primary prevention ICD implantation experience appropriate ICD interventions. Inducibility at electrophysiologic study and nonsustained ventricular tachycardia are independent strong predictors of appropriate ICD therapy. An increase in ventricular ectopy burden was associated with progressively lower event-free (appropriate ICD interventions) survival. Incremental risk of ventricular arrhythmias and ICD therapy was observed with the presence of multiple risk factors.

Original languageEnglish (US)
Pages (from-to)1485-1496
Number of pages12
JournalJournal of the American College of Cardiology
Volume58
Issue number14
DOIs
StatePublished - Sep 27 2011

Keywords

  • cardiomyopathy
  • electrophysiology
  • implantable cardioverter-defibrillators
  • sudden death
  • tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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