Right ventricular dysfunction in patients younger than 40 years and a history of sustained ventricular tachycardia have been predictors of appropriate implantable cardioverter-defibrillator interventions (DAI) in those with arrhythmogenic cardiomyopathy of the right ventricle (ARVC).
The research, published in the British journal The BMJ, has included 65 adult patients, with a mean age of 40 years, and of whom 48 were men. All of them had a diagnosis of arrhythmogenic cardiomyopathy (AM) who have had an ICD implanted for a period of 20 years, in primary (40 percent) or secondary (60 percent) prevention.
The study was terminated once the appropriate and inappropriate ICD interventions were carried out after implantation of the device in question.
During a median follow-up of 7.75 years after that implantation, nine patients died and six underwent heart transplantation. Appropriate ICD interventions occurred in 43 patients (66.2 percent) and inappropriate interventions in 18 patients (27.7 percent).
Multivariate analysis using a cause-specific risk model identified Three Predictors of Appropriate ICD Interventions: right ventricular dysfunction (cause-specific HR 2.85), age less than 40 years at the time of implantation (specific HR 2.37), and history of sustained ventricular tachycardia (VT) (specific HR 2.55). The researchers add that no predictors of inappropriate ICD discharges were found, and complications related to device implantation were described in 12 patients.
Arrhythmogenic cardiomyopathy has a higher risk of sudden death
MA is associated with a increased risk of sudden cardiac death and the stratification of arrhythmic risk is currently the subject of debate. The main objective of this observational study was to analyze the predictors of appropriate and inappropriate ICD intervention in patients with AM considered to be at high arrhythmic risk.
“This is a retrospective, observational, longitudinal and single-center design, with all the limitations of this type of design, but it provides us with some interesting data on a heart disease that is increasingly present in our clinical practice”, comments the Spanish Society of Cardiology (SEC). To this he adds that “despite being an autosomal dominant inheritance pathology, the different penetrance of the disease among carriers of the same mutation, even members of the same family, and the environmental and epigenetic factors that seem to modify the development of the heart disease often make arrhythmic risk stratification in this population very difficult.
“Furthermore, inappropriate ICD discharges in these patients (occurring in 27.7 percent of study subjects) are a non-negligible problem, which can contribute to impaired ventricular function and greatly limit quality of life.” “, he concludes.
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