Primary Prevention of Sudden Cardiac Death With Implantable Cardioverter-Defibrillator Therapy in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

Research output: Contribution to journalArticle

Abstract

Implantable cardioverter-defibrillator (ICD) therapy remains a corner stone of sudden cardiac death (SCD) prevention in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed to assess predictors of appropriate ICD therapies in the Scandinavian cohort of ARVC patients who received ICD for primary prevention of SCD. Study group comprised of 79 definite ARVC patients by 2010 Task Force criteria (60% male, age at ICD implant 39 ± 14 years) who were enrolled in the Nordic ARVC Registry and received an ICD for primary SCD prevention. The primary end point of appropriate ICD shock or death from any cause was assessed and compared with 137 definite ARVC patients who received ICD for secondary SCD prevention (74% male, age at ICD implant 42 ± 15 years). In the study group, 38% were ≤35 years of age at baseline, 25% had nonsustained ventricular tachycardia, and 29% had syncope at baseline. Major repolarization abnormality (hazard ratio = 4.00, 95% confidence interval 1.30 to 12.30, p = 0.015) and age ≤35 years (hazard ratio = 4.21, 95% confidence interval 1.49 to 11.85, p = 0.001) independently predicted the primary end point. The outcome did not differ between the primary prevention patients with either of these risk factors and the secondary prevention cohort (2% to 4% annual event rate) whereas patients without risk factors did not have any appropriate ICD shocks during follow-up. In conclusion, young age at ARVC diagnosis and major repolarization abnormality independently predict ICD shocks or death in the primary prevention ICD recipients and associated with the event rate similar to the one observed in the secondary prevention cohort. Our data indicate the benefit of ICD for primary prevention in patients with any of these risk factors.

Details

Authors
  • Pyotr G. Platonov
  • Kristina H. Haugaa
  • Henning Bundgaard
  • Anneli Svensson
  • Thomas Gilljam
  • Jim Hansen
  • Trine Madsen
  • Anders Gaarsdal Holst
  • Jonas Carlson
  • Øyvind H. Lie
  • Morten Kvistholm Jensen
  • Thor Edvardsen
  • Henrik K. Jensen
  • Jesper H. Svendsen
Organisations
External organisations
  • Norwegian Radium Hospital
  • University of Oslo
  • University of Copenhagen
  • Linköping University
  • Sahlgrenska University Hospital
  • Aalborg University
  • Aarhus University Hospital
  • Aarhus University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)1156-1162
JournalAmerican Journal of Cardiology
Volume123
Issue number7
Early online date2019 Jan 8
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes