Seasonal variation in the frequency of sudden cardiac death and ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: the effect of meteorological factors.
BACKGROUND
Sudden cardiac death (SCD) is the most catastrophic presentation in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).


OBJECTIVE
To investigate the seasonal variations in the frequency of SCD and ventricular tachyarrhythmia in patients with AVRD/C and to elucidate the meteorological factors that trigger these events.


METHODS
From 1998 to 2012, we enrolled 88 consecutive patients with ARVD/C from Taipei City. The cohort included 20 living patients who received implantable cardioverter-defibrillator (ICD) and 68 autopsied patients with SCD from the Taiwan National Forensic Institute registry. The baseline clinical characteristics, seasonal distribution, and associated meteorological factors were explored to predict the occurrences of events, which include appropriate ICD interventions and SCD.


RESULTS
There were 106 events, including 38 (35.8%, 1.9 episodes per patient) appropriate ICD interventions in living patients with ARVD/C and 68 (64.2%) SCD events. The seasonal peak occurred predominantly in summer (P < .05) in both groups. For meteorological factors, the onset of event was associated with higher average daily temperature and longer sunshine duration. The variation in humidity within 3 days of events was significantly increased. After multivariate logistic regression analysis, higher average daily temperature and larger variation in humidity were associated with increase in events (odds ratio 1.23, 95% confidence interval 1.16-1.31, P < .001, and odds ratio 1.19, 95% confidence interval 1.15-1.23, P < .001, respectively).


CONCLUSIONS
There was seasonal variation with a summer peak in the occurrence of ventricular arrhythmias and SCD in patients with ARVD/C. Meteorological factors including higher temperature and larger variation in humidity within 3 days of events were independently associated with the development of events.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Fa-Po
FP
Chung
Hsin-Ru
HR
Li
Eric
E
Chong
Chih-Hsin
CH
Pan
Yenn-Jiang
YJ
Lin
Shih-Lin
SL
Chang
Li-Wei
LW
Lo
Yu-Feng
YF
Hu
Ta-Chuan
TC
Tuan
Tze-Fan
TF
Chao
Jo-nan
JN
Liao
Wen-Yu
WY
Lin
Kai-Ping
KP
Shaw
Shih-Ann
SA
Chen
D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008685:Meteorological Concepts; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
ARVD/C; Arrhythmogenic right ventricular dysplasia/cardiomyopathy; CI; ECG; HR; ICD; Meteorological factors; OR; RV; SCD; SV; Seasonal variation; Sudden cardiac death; VF; VT; Ventricular tachyarrhythmia; arrhythmogenic right ventricular dysplasia/cardiomyopathy; confidence interval; electrocardiogram; heart rate; implantable cardioverter-defibrillator; odds ratio; right ventricle/ventricular; stroke volume; sudden cardiac death; ventricular fibrillation; ventricular tachycardia