title: Familial evaluation in arrhythmogenic right ventricular cardiomyopathy: impact of genetics and revised task force criteria.
abstract: BACKGROUND
  With recognition of disease-causing genes in arrhythmogenic right ventricular cardiomyopathy, mutation analysis is being applied.
  
  
  RESULTS
  The role of genotyping in familial assessment for arrhythmogenic right ventricular cardiomyopathy was investigated, including the prevalence of mutations in known causal genes, the penetrance and expressivity in genotyped families, and the utility of the 2010 Task Force criteria in clinical diagnosis. Clinical and molecular genetic evaluation was performed in 210 first-degree and 45 second-degree relatives from 100 families. In 51 families, the proband was deceased. The living probands had a high prevalence of ECG abnormalities (89%) and ventricular arrhythmia (78%) and evidence of more severe disease than relatives. Definite or probable causal mutations were found in 58% of families and 73% of living probands, of whom 28% had an additional desmosomal variant (ie, mutation or polymorphism). Ninety-three relatives had a causal mutation; 33% fulfilled the 2010 criteria, whereas only 19% satisfied the 1994 version (P=0.03). An additional desmosomal gene variant was found in 10% and was associated with a 5-fold increased risk of developing penetrant disease (odds ratio, 4.7; 95% confidence interval, 1.1 to 20.4; P=0.04).
  
  
  CONCLUSIONS
  Arrhythmogenic right ventricular cardiomyopathy is a genetically complex disease characterized by marked intrafamilial phenotype diversity. Penetrance is definition dependent and is greater with the 2010 criteria compared with the 1994 criteria. Relatives harboring >1 genetic variant had significantly increased risk of developing clinical disease, potentially an important determinant of the phenotypic heterogeneity seen within families with arrhythmogenic right ventricular cardiomyopathy.
authors: Heart Hospital, University College London Hospitals Trust, London, UK.
authors: Giovanni
authors: G
authors: Quarta
authors: Alison
authors: A
authors: Muir
authors: Antonios
authors: A
authors: Pantazis
authors: Petros
authors: P
authors: Syrris
authors: Katja
authors: K
authors: Gehmlich
authors: Pablo
authors: P
authors: Garcia-Pavia
authors: Deirdre
authors: D
authors: Ward
authors: Srijita
authors: S
authors: Sen-Chowdhry
authors: Perry M
authors: PM
authors: Elliott
authors: William J
authors: WJ
authors: McKenna