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(Circulation. 2009;119:2426-2434.)
© 2009 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Incidence and Risk Factors of Arrhythmic Events in Catecholaminergic Polymorphic Ventricular Tachycardia

Meiso Hayashi, MD; Isabelle Denjoy, MD; Fabrice Extramiana, MD, PhD; Alice Maltret, MD; Nathalie Roux Buisson, MD; Jean-Marc Lupoglazoff, MD, PhD; Didier Klug, MD; Miyuki Hayashi, MD; Seiji Takatsuki, MD; Elisabeth Villain, MD; Joël Kamblock, MD; Anne Messali, MD; Pascale Guicheney, PhD; Joël Lunardi, MD, PhD; Antoine Leenhardt, MD

From the Service de Cardiologie (Meiso Hayashi, I.D., F.E., Miyuki Hayashi, S.T., A.M., A.L.), Hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris, Université Paris Diderot, INSERM U942, Paris, France; Cardiologie Pédiatrique (A.M., E.V.), Hôpital Necker-Enfants-Malades, Paris, France; Laboratoire de Biochimie et Génétique Moléculaire (N.R.B., J.L.), CHU Grenoble, France; Unité de Cardiologie Néonatale (J.-M.L.), Hôpital Robert-Debré, Paris, France; Hôpital Cardiologique de Lille (D.K.), Lille, France; Centre de Cardiologie du Taaone (J.K.), Tahiti, French Polynesia; and INSERM U582 (P.G.), Institut de Myologie, Groupe hospitalier Pitié-Salpêtrière, Paris, France.

Correspondence to Antoine Leenhardt, MD, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique–Hopitaux de Paris, Université Paris Diderot, INSERM U942, 2 Rue Ambroise Paré, 75475 Paris Cedex 10, France. E-mail antoine.leenhardt{at}lrb.aphp.fr

Received October 17, 2008; accepted February 23, 2009.

Background— The pathophysiological background of catecholaminergic polymorphic ventricular tachycardia is well understood, but the clinical features of this stress-induced arrhythmic disorder, especially the incidence and risk factors of arrhythmic events, have not been fully ascertained.

Methods and Results— The outcome in 101 catecholaminergic polymorphic ventricular tachycardia patients, including 50 probands, was analyzed. During a mean follow-up of 7.9 years, cardiac events defined as syncope, aborted cardiac arrest, including appropriate discharges from implantable defibrillators, or sudden cardiac death occurred in 27 patients, including 2 mutation carriers with normal exercise tests. The estimated 8-year event rate was 32% in the total population and 27% and 58% in the patients with and without β-blockers, respectively. Absence of β-blockers (hazard ratio [HR], 5.48; 95% CI, 1.80 to 16.68) and younger age at diagnosis (HR, 0.54 per decade; 95% CI, 0.33 to 0.89) were independent predictors. Fatal or near-fatal events defined as aborted cardiac arrest or sudden cardiac death occurred in 13 patients, resulting in an estimated 8-year event rate of 13%. Absence of β-blockers (HR, 5.54; 95% CI, 1.17 to 26.15) and history of aborted cardiac arrest (HR, 13.01; 95% CI, 2.48 to 68.21) were independent predictors. No difference was observed in cardiac and fatal or near-fatal event rates between probands and family members.

Conclusions— Cardiac and fatal or near-fatal events were not rare in both catecholaminergic polymorphic ventricular tachycardia probands and affected family members during the long-term follow-up, even while taking β-blockers, which was associated with a lower event rate. Further studies evaluating concomitant therapies are necessary to improve outcome in these patients.

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Clinical Summaries
Circulation 2009 119: 2417-2419. [Extract] [Full Text]