Abstract 12056: Inducible Ventricular Tachycardia Predicts Long-Term Adverse Outcome in Arrhythmogenic Right Ventricular Cardiomyopathy
Introduction: The role of electrophysiological (EP) testing for risk stratification in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is controversial.
Hypothesis: Inducibility of sustained monomorphic ventricular tachycardia (SMVT) predicts an adverse outcome.
Methods: From 101 patients who fulfilled the 2010 Revised Task Force Criteria for ARVC at the University Hospital of Zurich, the clinical outcome of 62 patients who underwent EP testing was analyzed.
Results: During a median follow-up of 9.8 years (interquartile range 4.4-12.5 years), 30 patients (48.4%) experienced an adverse outcome (cardiac death, heart transplant, sudden cardiac arrest, ventricular fibrillation, VT with hemodynamic compromise or syncope). EP testing demonstrated SMVT in 34 patients (54.8%). Of those, 22 (64.7%) had an adverse outcome. Conversely, in 28 patients without inducible SMVT, 8 (28.6%) had an adverse outcome. Inducibility of SMVT (hazard ratio, HR 2.87; 95% CI 1.27-6.46), non-adherence to antiarrhythmic drug use and restriction from strenuous exercise (HR 2.86; 95% CI 1.36-6.01), syncope (HR 2.38; 95% CI 1.13-5.03) and sustained VT with hemodynamic compromise/ VF prior to EP testing (HR 2.19; 95% CI 1.07-4.49) were predictive for an adverse outcome. Kaplan-Meier analysis showed a significant event-free survival benefit for patients without inducible SMVT (log-rank p=0.008) with a cumulative survival free of adverse events of 76% [95% CI 61-95%] and 72% [95% CI 56-92%] in the group without inducible SMVT as compared to 42% [95% CI 28-64%] and 26% [95% CI 14-50%] in the other group after 5 and 10 years, respectively.
Conclusion: This long-term observational data suggests that SMVT inducibility during EP testing may predict an adverse outcome. Besides established risk factors such as syncope and spontaneous ventricular arrhythmias with hemodynamic compromise, non-adherence may be an additional risk factor for adverse events in patients with ARVC.
- Risk factors
- Implantable cardioconvert defibrillator
- Ventricular tachycardia
- © 2012 by American Heart Association, Inc.