Abstract 15766: Implantable Cardioverter-Defibrillator Therapy in Arrhythmogenic Right Ventricular Cardiomyopathy: long-term single centre experience.
Introduction: ARVC is a heart-muscle disease characterized by progressive fibrofatty substitution leading to heart failure (HF) and sudden cardiac death (SCD). In this setting whether to implant an ICD is a pivotal decision.
Hypothesis: evaluate long-term prognosis of ARVC patients who underwent ICD implantation to determine clinical predictors of appropriate ICD discharges.
Methods: Twenty-two patients (16 men, 73%) with ARVC diagnosis (1994 Task Force Criteria) underwent ICD implantation. Sixteen (73%) patients were implanted in secondary prevention (3 for aborted SCD and 13 for sustained ventricular tachycardia (SVT) despite drug therapy) and 6 (27%) in primary prevention (3 for family history of SCD, 2 for inducibility of ventricular arrhythmias with hemodynamic compromise and 1 for biventricular HF). Appropriate interventions (AI) were considered: anti-tachycardia pacing on SVT; internal shock on SVT or VF. Internal shock triggered by supraventricular tachyarrhythmias or device malfunction was recorded as an inappropriate intervention (II).
Results: After 7.1±3.6 years follow-up, AI were experienced by 14 (88%) and none patients implanted in secondary and in primary prevention respectively. II were experienced by 3 (14%) patients implanted in secondary prevention and 1 (4.5%) in primary prevention. Finally 4 (18%) and 1 (4.5%) patients in secondary and primary prevention respectively presented implantation complications. Three patients died, 2 for HF and 1 for uremia, and one underwent heart transplant. Based on clinical variables an increased QRS duration in lead V1 (p=0.024), a progressive enlargement of the right ventricle (RV) outflow tract (p=0.015) and the presence of RV dyskinesia (p=0.03) related with AI during the long-term follow-up (p values for Pearson Chi square or one way ANOVA as needed).
Conclusions: ICD is a life saving therapy in preventing SCD, but HF related deaths still affect ARVC patient's long-term prognosis. The high incidence of II and device-related complications (18.5% and 22.5%, respectively) remains a relevant problem. Finally, the absence of AI within patients implanted in primary prevention underlines the need of more precise risk stratification to avoid unnecessary implants and related complications.
- © 2010 by American Heart Association, Inc.