Publication details

Clinical Role of Atrial Arrhythmias in Patients With Arrhythmogenic Right Ventricular Dysplasia

Authors	SAGUNER AM GANAHL S KRAUS Andrea BALDINGER SH MEDEIROS-DOMINGO A SAGUNER AR MUELLER-BURRI SA WOLBER T HAEGELI LM KRASNIQI N TANNER FC STEFFEL J BRUNCKHORST C DURU F
Year of publication	2014
Type	Article in Periodical
Magazine / Source	Circulation Journal
Citation
Doi	http://dx.doi.org/10.1253/circj.CJ-14-0474
Keywords	Arrhythmogenic right ventricular dysplasia; Atrial fibrillation; Atrial flutter; Cardiomyopathy
Description	Background: The clinical role of atrial fibrillation/atrial flutter (AF-AFl) and variables predicting these arrhythmias are not well defined in patients with arrhythmogenic right ventricular dysplasia (ARVD). We hypothesized that transthoracic echocardiography (TTE) and 12-lead electrocardiography (ECG) would be helpful in predicting AF-AFl in these patients. Methods and Results: ECGs and TTEs of 90 patients diagnosed with definite or borderline ARVD (2010 Task Force Criteria) were analyzed. Data were compared in (1) patients with AF-AFl and (2) all other patients. A total of 18 (20%) patients experienced AF-AFl during a median follow-up of 5.8 years (interquartile range 2.0-10.4). Kaplan-Meier analysis revealed reduced times to AF-AFl among patients with echocardiographic RV fractional area change <27% (P<0.001), left atrial diameter >= 24.4 mm/m(2) (parasternal long-axis, P=0.001), and right atrial short-axis diameter >= 22.1 mm/m(2) (apical 4-chamber view, P=0.05). From all ECG variables, P mitrale conferred the highest hazard ratio (3.37, 95% confidence interval 0.92-12.36, P=0.067). Five patients with AF-AFl experienced inappropriate implantable cardioverter-defibrillator (ICD) shocks compared with 4 without AF-AFl (36% vs. 9%, P=0.03). AF-AFl was more prevalent in heart-transplant patients and those who died of cardiac causes (56% vs. 16%, P=0.014). Conclusions: AF-AFl is associated with inappropriate ICD shocks, heart transplantation, and cardiac death in patients with ARVD. Evidence of reduced RV function and atrial dilation helps to identify the ARVD patients at increased risk for AF-AFl.